For Some Thyroid Cancer Patients, Less is More

Patients with small thyroid tumors may be just as likely to hear their doctor recommend partial thyroid removal as a total removal, based on new treatment guidelines that were released by the American Thyroid Association (ATA) in October 2015. This change is part of a shift toward “less is more” when it comes to thyroid cancer treatment, says Julie Ann Sosa, MD, chief of endocrine surgery and leader of the endocrine neoplasia diseases group at Duke Cancer Institute and Duke Clinical Research Institute. “We are probably overtreating many low-risk differentiated thyroid cancers, both with surgery and with radioactive iodine.”

Sosa was among four surgeons who served on the task force that wrote the new recommendations, and she and Duke colleagues conducted a study that was pivotal in the discussion about how extent of surgery is associated with patient outcomes. That study analyzed more than 61,000 cases and found that, contrary to older guidance, removal of the entire thyroid (total thyroidectomy) does not give a survival advantage when the tumor is small (less than 4 centimeters) and deemed to be low-risk. In those cases, patients who choose lobectomy (removal of only the part of the thyroid that contains the tumor) can live just as long, and often with fewer side effects.  

“This is a gray area. There’s an opportunity for choice there.”--Julie Ann Sosa, MD

“If we take your entire thyroid out, you have to take a medicine every day, so that’s a true quality-of-life issue,” Sosa says. Among patients who have only part of the thyroid removed, the majority don’t have to take medication at all. In addition, Sosa says, the total thyroid removal carries a greater risk of other complications, including losing the ability to speak or breathe unassisted and having to take calcium supplements several times a day.

The upshot—in patients with small tumors, the extent of their disease, as well as the patient’s preference, should weigh heavily as a deciding factor. “This is a gray area,” Sosa says. “There’s an opportunity for choice there.”

Sosa also serves on the board of directors of the American Thyroid Association.