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?

BackgroundOur original system for risk group classification for predicting cause-specific death from papillary thyroid carcinoma (PTC) defined patients with distant metastasis and older patients (≥50 years) with either massive extrathyroidal extension or large (≥3 cm) lymph node metastasis as high risk; all others are low risk. For unilateral, low-risk PTC, the extent of thyroidectomy (less-than-total thyroidectomy vs total or near-total thyroidectomy) has been determined based on the choice of the patient since 2005.PatientsOf 1,187 patients who underwent initial thyroidectomy for PTC (tumor size [T] >1 cm) between 1993 and 2010, 967 (82%) were classified as low risk. Among low-risk patients, 791 (82%) underwent less than total thyroidectomy.ResultsThe 10-year cause-specific survival and disease-free survival rates did not differ between patients who underwent total thyroidectomy versus less than total thyroidectomy (cause-specific survival, 99% vs 99% [P = .61]; disease-free survival, 91% vs 87% [P = .90]). Age ≥60 years, T ≥3 cm, and lymph node metastases >3 cm represented significant risk factors for distant recurrence.ConclusionThe favorable overall survival of low-risk patients, regardless of the extent of thyroidectomy, supports patient autonomy in treatment-related decision making. Low-risk patients possessing risk factors for distant recurrence would be likely to benefit from total thyroidectomy followed by radioactive iodine.