Risk-adapted management of papillary thyroid carcinoma according to our own risk group classification system: Is thyroid lobectomy the treatment of choice for low-risk patients?

The prognostic value of serum thyroid‐stimulating hormone level post‐lobectomy in low‐ and intermediate‐risk papillary thyroid carcinoma

“…Given the need to balance the benefits of TSH suppression with its adverse effects, the 2015 ATA guidelines now recommend that the decision to use TSH suppression, along with the intensity of treatment, be based on an initial risk stratification during the early postoperative period and on dynamic risk stratification in the long term . Because the ability of dynamic risk stratification to predict structural recurrence has been reported to be greater than that of ATA initial risk estimates (62% to 84% versus < 30%), TSH‐suppression therapy and the target range of TSH levels in the long term should be based on dynamic risk stratification .…”

The new 4th edition World Health Organization classification for thyroid tumors, Asian perspectives

“…classified PTC into low risk and high risk groups for disease recurrence based on features of so‐called aggressive histology (tall/columnar cell, micropapillary/discohesive and solid variant PTC) in 2008, and some other Japanese studies risk‐stratified follicular cell thyroid carcinomas into three groups (low‐risk, moderate‐risk and high‐risk) using clinical features, the Ki67 proliferation index and thyroglobulin doubling time . In 2009, the previous ATA clinical guidelines recommended risk stratification of differentiated thyroid carcinomas into low‐risk, intermediate‐risk and high‐risk for structural disease recurrence using a combination of histopathological parameters and clinical features, and was updated in 2016 (Table ) to guide management and determine the need for radioactive iodine ablation therapy, so‐called risk adapted management . The histopathological parameters used for risk stratification were the presence of (i) aggressive histology (diffuse sclerosing, tall cell, columnar cell, hobnail and solid variant PTC), (ii) minor (microscopic) and gross extrathyroidal extension, (iii) more than four or fewer than four foci of vascular invasion, (iv) extranodal invasion, (v) fewer than five involved lymph nodes (less than 0.2 cm metastasis), (vi) more than five involved lymph nodes (0.2–3 cm), and (vii) intrathyroidal (ex0, N0, M0) differentiated thyroid carcinomas (Table ).…”

Surgical Risk after Unilateral Lobectomy versus Total Thyroidectomy: A Review of 47,434 Patients

“…Lee et al made a similar conclusion in their study of 2,014 patients [20]. However, Ebina et al found decreased survival after UL in patients > 50 years old, those with massive extrathyroidal extension, or large (>3 cm) lymph node metastasis) in a study of 1,187 patients from a single center [21]. Of note, none of these studies evaluated surgical outcomes after TT versus UL, as the respective datasets were not capable of analyzing these outcomes.…”