An audit of the management of thyroid cancer in a district general hospital

Vanderpump, Mark; Alexander, Lukas K.; Scarpello, J. H. B.; Clayton, R. N.

doi:10.1046/j.1365-2265.1998.00469.x

Cited by 22 publications

(12 citation statements)

References 22 publications

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“…The Second Consensus Document also recommends that the optimal team membership of a multidisciplinary clinic should be an endocrinologist, specialist surgeon, thyroid cyto‐pathologist, radiologist, clinical oncologist, and MacMillan specialist nurse. From audit in the UK, there is evidence that inadequate surgery and failure to administer radioiodine were less common in those patients managed in a specialist clinic setting than those managed in other clinic settings 12,13 . In total, 35% of ENT surgeons manage their thyroid patients in a multidisciplinary clinic, although the constituents of these are not known.…”

Section: Discussionmentioning

confidence: 99%

Who performs thyroid surgery: a review of current otolaryngological practice

et al. 2002

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Thyroid surgery has been traditionally a general surgical practice, but recently more otolaryngologists have been offering a thyroid service. We have quantified thyroid surgery performed by the different specialties, and looked more closely at the practice of otolaryngologists. Data was obtained from the Department of Health for UK thyroid surgery in all specialties for the year 1998-99 and validated against a survey of members of the British Association of Otolaryngologists-Head & Neck Surgeons (BAO-HNS). The use of investigations of a simple clinical case (solitary thyroid nodule) was compared with best practice. General surgeons still perform the majority of thyroid surgery (83%) but ENT surgeons now perform significant numbers (15.4% of all cases), which translates to 1499 cases per annum. A total of 102 BAO-HNS members were performing thyroid surgery with an average case-load of 19.1 per year. In total, 35% of ENT surgeons see thyroid patients in multidisciplinary clinics. The choice of investigation is consistent with European guidelines. ENT surgeons are doing significant amounts of thyroid surgery and the numbers appear to be increasing. The formation of multidisciplinary teams including general surgeons and otolaryngologists who are committed to subspecialization can only improve both training and treatment outcomes.

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Section: Discussionmentioning

confidence: 99%

Who performs thyroid surgery: a review of current otolaryngological practice

et al. 2002

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“…An audit of care found many deficiencies in practice, citing inadequacies in the areas of surgery (20%), suppression of thyroxine (T 4 ) (20%), monitoring by serum Tg (15%) and the use of 131 I treatment (12%) (Kumar et al 2001). Others identify similar problems in Europe and the USA (Hardy et al 1995, Hundahl et al 1998, Vanderpump et al 1998. Because of these deficiencies, leaders in Great Britain (Kendall-Taylor 2001) called for the establishment of guidelines for the management of thyroid cancer.…”

Section: Management Planmentioning

confidence: 99%

Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin.

Mazzaferri¹,

Massoll²

2002

Endocrine-Related Cancer

161

113

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The incidence of differentiated thyroid cancer (DTC) has increased in many places around the world over the past three decades, yet this has been associated with a significant decrease in DTC mortality rates in some countries. While the best 10-year DTC survival rates are about 90%, long-term relapse rates remain high, in the order of 20-40%, depending upon the patient's age and tumor stage at the time of initial treatment. About 80% of patients appear to be rendered disease-free by initial treatment, but the others have persistent tumor, sometimes found decades later. Optimal treatment for tumors that are likely to relapse or cause death is total thyroidectomy and ablation by iodine-131 ( 131 I), followed by long-term levothyroxine suppression of thyrotropin (TSH). On the basis of regression modeling of 1510 patients without distant metastases at the time of initial treatment and including surgical and 131 I treatment, the likelihood of death from DTC is increased by several factors, including age > 45 years, tumor size > 1.0 cm, local tumor invasion or regional lymph-node metastases, follicular histology, and delay of treatment > 12 months. Cancer mortality is favorably and independently affected by female sex, total or near-total thyroidectomy, 131 I treatment and levothyroxine suppression of TSH. Treatments with 131 I to ablate thyroid remnants and residual disease are independent prognostic variables favorably influencing distant tumor relapse and cancer death rates. Delay in treatment of persistent disease has a profound impact on outcome.Optimal long-term follow-up using serum thyroglobulin (Tg) measurements and diagnostic whole-body scans (DxWBS) require high concentrations of TSH, which until recently were possible to achieve only by withdrawing levothyroxine treatment, producing symptomatic hypothyroidism. New paradigms, however, provide alternative pathways to prepare patients for 131 I treatment and to optimize follow-up. Patients with undetectable or low Tg concentrations and persistent occult disease can now be identified within the first year after initial treatment by recombinant human (rh)TSH-stimulated serum Tg concentrations greater than 2 µg/l, without performing DxWBS. These new follow-up paradigms promptly identify patients with lung metastases that are not evident on routine imaging, but which respond to 131 I treatment. In addition, rhTSH can be given to prepare patients for 131 I remnant ablation or 131 I treatment for metastases, especially those who are unable to withstand hypothyroidism because of concurrent illness or advanced age, or whose hypothyroid TSH fails to increase.

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“…Several factors determine the long-term survival in differentiated TC, including age, gender, distant metastases, and initial treatment (36)(37)(38)(39). Although we lack complete data on the treatment of patients, total thyroidectomy and iodine ablation became much more common in Israel for differentiated TC (40,41).…”

mentioning

confidence: 98%

Time Trends of Incidence Rates of Thyroid Cancer in Israel: What Might Explain the Sharp Increase

Lubina

Cohen

Barchana

et al. 2006

Thyroid

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A marked increase in TC incidence over the last two decades (mainly due to papillary carcinoma) has been noted in different Israeli subpopulations, being the highest in Jewish women. The increase trends were similar regardless of gender or ethnicity. The reasons for this rise in TC incidence and improvement in the survival are probably multifactorial and may relate partly to increased diagnostic vigilance and changes in clinical practice.

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An audit of the management of thyroid cancer in a district general hospital

Cited by 22 publications

References 22 publications

Who performs thyroid surgery: a review of current otolaryngological practice

Who performs thyroid surgery: a review of current otolaryngological practice

Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin.

Time Trends of Incidence Rates of Thyroid Cancer in Israel: What Might Explain the Sharp Increase

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