Consensus-based management of differentiated thyroid cancer in a tertiary care set-up

Abstract

Introduction This study describes the experience of a tertiary care hospital in the management of differentiated thyroid cancer. Thyroid cancer accounts for less than 1% of all human malignancy. Nevertheless, it is the commonest endocrine malignancy constituting 90% of endocrine cancers. It is the commonest cancer in Saudi Arabian women second to breast cancer. This fact makes differentiated thyroid cancer an important tumor and a challenging disease. Methods The medical records of patients diagnosed to have differentiated thyroid cancer in King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia between 1st January 2000 and 30th September 2006 were reviewed retrospectively. The data included patient’s demographic details, clinical diagnoses, co-morbid conditions, relevant investigations, imaging studies, medical and surgical treatment offered, types of surgeries performed, radioactive iodine therapy given, and the complications and outcome of management. Management of these patients follows a clinical care pathway set up by the hospital Thyroid Cancer Group representing various multidisciplinary team members. Results One hundred and eight medical records were reviewed. Of these, 72 (66.7%) patients were females and 36 (33.3%) were males. Median age for the females was 40 years, and for males 45 years. Ninety patients (83.3%) had a papillary carcinoma, four patients (3.7%) had a follicular carcinoma and fourteen patients (13%) had other types, namely medullary thyroid carcinoma, anaplastic carcinoma and lymphoma. A total of 78 patients underwent various forms of surgery in our hospital and the remaining patients underwent operation in the district hospitals before they were referred to our centre for further management. Complications included bleeding (1.8%), voice changes (4.5%), and hypocalcaemia (3.8%). The overall outcome showed that 99 patients (91.7%) were alive and well at the time of analysis, 4 patients (3.7%) died and 5 patients (4.6%) were lost to follow up. Conclusions This hospital-based epidemiological study, the largest one done in the western part of Saudi Arabia, showed that differentiated thyroid cancer behavior and the management approach we adopt is not different from other centres of excellence. In spite of the relatively higher number of redo surgery we performed in these patients, yet the incidence of recurrent laryngeal nerve injury and hypocalcaemia are similar to what is published in the literature.