Use Of Thyroidectomy Research Articles

Increasing Use of Thyroidectomy as Definitive Treatment for Hyperthyroidism

BackgroundThyroidectomy is a definitive treatment for hyperthyroidism. The purpose of this study is to examine how often patients with hyperthyroidism are referred for thyroidectomy and what are the common reasons for referral. Materials and methodsWe identified 864 patients with hyperthyroidism diagnosis. A total of 237 patients underwent thyroidectomy from January 2011 to December 2016. Patients were divided into six groups according to the year of thyroidectomy, group 1 to group 6, from 2011 to 2016, respectively. Primary and secondary outcomes: reasons why patient was referred for thyroidectomy, time from diagnosis, and/or start of antithyroid drugs (ATDs) to thyroidectomy as well as the trend and total number of thyroidectomies each surgeon did during the study period. ResultsThe mean age was 44 ± 15 y, 73% were women, and 54% were African American. A significant increase in the rate of thyroidectomy over the study period was observed where 31 patients underwent thyroidectomy in 2011 compared with 61 patients in 2016. The most common reasons patients were referred for thyroidectomy were resistance or intolerance to ATDs followed by patient's preference, and presentation with obstructive symptoms with no statistically significant difference between groups. The median time from diagnosis to surgery was 8 mo (0 to 204 mo) and 7 mo from initiation of ATDs to thyroidectomy with no significant difference between groups. ConclusionsAn increase of thyroidectomy rate was observed at our institution over the last 6 y. Patients were mostly referred due to resistance or intolerance to antithyroid medications, patients’ preference of surgery, and presentation with obstructive symptoms.

Total thyroidectomy in Basedow-Graves� disease treatment: our experience

In the present study the authors, after a short historical description of the Basedow-Graves' disease, describe their case-study gathered over the last five years. They mention the most widely accepted hypothesis regarding disease's etiology, strongly linked to autoimmune disorders, and the role that some viral agents (Coksackie B and HTLV-II) may have in initiating autoantibody production and T cells activation in genetically predisposed individuals. Basic and clinical aspects of the diagnosis and disease treatment, highlighting the use of thyroidectomy, are addressed. They conclude that total thyroidectomy represents today the treatment of choice, which, after appropriate preparation to reach the euthyroidism condition, can ensure a successful cure.

Utilization of thyroidectomy for benign disease in the United States: a 15-year population-based study

Background Recent recommendations suggest that total thyroidectomy (TT) is the preferred treatment for benign thyroid disease. This approach remains controversial because of the increased risk of morbidity compared with a partial thyroidectomy (PT). The aim of this study was to determine the use of thyroidectomy for benign disease over a 15-year period. Methods One hundred nineteen thousand eight hundred eighty-five patients from the Nationwide Inpatient Sample database (1993–2007) underwent surgery for benign thyroid disease. Logistic regression was used to assess the relation between extent of thyroidectomy and the year of admission, hospital volume, and surgical outcomes. Results The use of TT increased from 17.6% (1993–1997) to 39.6% (2003–2007) compared with 82.4% and 60.4% for PT over the same periods ( P < .0001). A greater proportion of TTs was performed in high-volume centers in which the rates of postoperative complications were lower than low-volume centers. Conclusions The use of TT for benign thyroid disease has increased over the last 15 years in the United States. This pattern of practice is in keeping with the trends reported in recent literature.

Medullary Thyroid Cancer: Are Practice Patterns in the United States Discordant From American Thyroid Association Guidelines?

Surgery is the mainstay of treatment for medullary thyroid cancer (MTC), with long-term patient outcomes associated with adequacy of resection. This study benchmarked national practice patterns against 2009 American Thyroid Association (ATA) guidelines for MTC regarding use of thyroidectomy, lymphadenectomy, radioactive iodine (RAI), and external-beam radiotherapy (EBRT). This is a cross-sectional, retrospective cohort study of MTC patients in the Surveillance, Epidemiology, and End Results Program database, 1973 to 2006. ATA recommendations 61 to 66 (extent of surgery), 85 (RAI), and 93 (EBRT) were analyzed. Outcome of interest was practice accordance with these recommendations. Predictors of accordance were determined and Kaplan-Meier survival analyses were performed. A total of 2033 patients with MTC were identified. Fifty-nine percent were women; 78% were white. Forty-one percent of patients did not receive appropriate surgical therapy (recommendations 61 to 63). Most patients with distant metastatic disease had less aggressive surgery and more EBRT (P < 0.001) (recommendations 64 to 66). Four percent of patients received inappropriate RAI (recommendation 85). Two hundred nine patients had gross incomplete resections, with 33% receiving postoperative EBRT (recommendation 93). Statistically significant predictors of receiving surgery discordant with ATA recommendations in multivariate analysis were patient age >65, female sex, earlier year of diagnosis (1988 to 1997), geographic region, intrathyroidal tumor extent, and tumor size of </=1 cm. Patients receiving surgery discordant with recommendations had shorter survival than those receiving surgery according to recommendations (P < 0.05). Variation in practice patterns exist in the United States with regard to extent of surgery and lymphadenectomy for MTC. Dissemination of standardized guidelines is important to ensure optimal treatment with less variation in quality of care.

Treatment patterns of aging Americans with differentiated thyroid cancer

The incidence of differentiated thyroid cancer (DTC) increases with age. Total thyroidectomy, often followed by radioactive iodine (RAI), is recommended for patients who have tumors that measure > or =1 cm in greatest dimension. In the current study, the authors assessed the use of thyroidectomy and RAI among elderly patients with DTC and the effects on survival. Adults aged > or =45 years with DTC > or =1 cm in the Surveillance, Epidemiology, and End Results database from 1988 to 2003 were included. Bivariate and multivariate analyses were used to measure associations between demographic, clinical, and pathologic characteristics and the likelihood of receiving treatment according to current practice guidelines. Of 8899 patients who were identified, 26% were ages 65 years to 79 years, and 5% were aged > or =80 years. Compared with younger patients, patients aged > or = 65 years were more likely to have larger tumors, stage IV disease, extrathyroid extension, and nonpapillary histology. Elderly patients were less likely to undergo total thyroidectomy (74% vs 80%; P < .001) or to receive RAI (47% vs 54%; P < .001). These trends were most pronounced among those aged > or =80 years. Among the patients who did not undergo surgery, elderly patients did not report higher rates of contraindications to surgery. In multivariate analysis, the groups ages 65 years to 79 years and aged > or =80 years were associated with lower rates of total thyroidectomy (odds ratio, 0.77 and 0.43, respectively; P < .001) and RAI (odds ratio, 0.85 [P < .01] and 0.39 [P < .001], respectively). Among elderly patients, predictors of worse survival included no surgery (hazard ratio, 5.51; P < .001) and no RAI (hazard ratio, 1.36; P < .001). Elderly patients with DTC received less aggressive surgical and RAI treatment than younger patients despite having more advanced disease and the improved survival associated with these treatments among elderly patients. Long-term outcomes should be measured to determine the impact of this apparent discrepancy in care.

Optimisation of thyroid hormone replacement using an automated thyroid register

The high prevalence of thyroid dysfunction requires an efficient and effective means of monitoring and adjustment. We compared the current network of 12,524 patients with thyroid dysfunction with register data prior to 1991 to examine the precision of thyroxine replacement in patients with hypothyroidism and assess locally changing trends in treatment of hyperthyroidism. Since 1991, due to the associated adverse effects of a suppressed thyroid-stimulating hormone (TSH) (<0.03 mU/l), the network has facilitated a significant reduction in the proportion of thyroxine-treated patients with TSH suppression from 58.5% before 1991 to 9.2 +/- 3.8% thereafter. Since 1991, there has been an increased use of radioiodine by 14.3% [95% confidence interval (95% CI): 10.6-17.8] and a reduced use of thyroidectomy by 12.3% (95% CI: 8.8-15.8) to treat hyperthyroid patients compared with before 1991. Between the two treatments, there were no differences in subsequent rates of hypothyroidism or mean thyroxine dosage.