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Reasons Associated with Total Thyroidectomy as Initial Surgical Management of an Indeterminate Thyroid Nodule

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Diagnostic hemithyroidectomy (HT) is the most widely recommended surgical procedure for a nodule with indeterminate cytology; however, additional details may make initial total thyroidectomy (TT) preferable. We sought to identify patient-specific factors (PSFs) associated with initial TT in patients with indeterminate thyroid nodules.

Methods

Retrospective analysis of all patients with a thyroid nodule ≥ 1 cm and initial cytology of atypia of undetermined significance or suspicious for follicular neoplasm between 2012 and 2015 who underwent thyroidectomy. Medical records were reviewed for patient demographics, neck symptoms, nodule size, cytology, molecular test results, final histopathology, and additional PSFs influencing surgical management. Variables were analyzed to determine associations with the use of initial TT. Logistic regression analyses were performed to identify independent associations.

Results

Of 325 included patients, 182/325 (56.0%) had HT and 143/325 (44.0%) had TT. While patient age and sex, nodule size, and cytology result were not associated with initial treatment, five PSFs were associated with initial TT (p < 0.0001). These included contralateral nodules, hypothyroidism, fluorodeoxyglucose avidity on positron emission tomography scan, family history of thyroid cancer, and increased surgical risk. At least one PSF was present in 126/143 (88.1%) TT patients versus 47/182 (25.8%) HT patients (p < 0.0001). Multivariate logistic regression analysis demonstrated that these variables were the strongest independent predictor of TT (odds ratio 45.93, 95% confidence interval 18.80–112.23, p < 0.001).

Conclusions

When surgical management of an indeterminate cytology thyroid nodule was performed, several PSFs were associated with a preference by surgeons and patients for initial TT, which may be useful to consider in making decisions on initial operative extent.

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Acknowledgements

None.

Disclosures

Trevor E. Angell has received research support from Veracyte Inc., and Erik K. Alexander is a consultant for Veracyte, Inc. Chirag M. Vyas, Justine A. Barletta, Edmund S. Cibas, Nancy L. Cho, Gerard M. Doherty, Atul A. Gawande, Brooke E. Howitt, Jeffrey F. Krane, Ellen Marqusee, Kyle C. Strickland, Francis D. Moore Jr, and Matthew Nehs have no relevant conflicts of interest to declare.

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Authors and Affiliations

  1. The Thyroid Section, Division of Endocrinology, Diabetes and Hypertension, The Brigham & Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Trevor E. Angell MD, Chirag M. Vyas MBBS, MPH, Ellen Marqusee MD & Erik K. Alexander MD

  2. Department of Pathology, The Brigham & Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Justine A. Barletta MD, Edmund S. Cibas MD, Brooke E. Howitt MD, Jeffrey F. Krane MD, PhD & Kyle C. Strickland MD, PhD

  3. Department of Surgery, The Brigham & Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Nancy L. Cho MD, Gerard M. Doherty MD, Atul A. Gawande MD, Francis D. Moore Jr. MD & Matthew A. Nehs MD

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  1. Trevor E. Angell MD
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  2. Chirag M. Vyas MBBS, MPH
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  12. Erik K. Alexander MD
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  14. Matthew A. Nehs MD
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Correspondence to Matthew A. Nehs MD.

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Angell, T.E., Vyas, C.M., Barletta, J.A. et al. Reasons Associated with Total Thyroidectomy as Initial Surgical Management of an Indeterminate Thyroid Nodule. Ann Surg Oncol 25, 1410–1417 (2018). https://doi.org/10.1245/s10434-018-6421-x

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  • DOI: https://doi.org/10.1245/s10434-018-6421-x

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