The following is a summary of “American Thyroid Association Guidelines and National Trends in Management of Papillary Thyroid Carcinoma” published in the November 2022 issue of Otolaryngol Head Neck Surgery by Gordon et al.

In recent years, the American Thyroid Association (ATA) has advocated for less aggressive treatment of well-differentiated thyroid tumors in its guidelines. To assess whether low-risk papillary thyroid carcinomas were managed differently across the country due to the 2009 and 2015 ATA guidelines. To conduct this retrospective cohort analysis, researchers accessed the National Cancer Database. Using the National Cancer Database, they chose all cases of papillary thyroid cancer detected between 2004 and 2019. All patients with metastases, tumors larger than 4 cm, or clinical signs of nodal illness were excluded. The time period covered by the data analysis was August 1, 2021 through September 1, 2022.

The primary objective was to compare the rates of total thyroidectomy (TT), total lobectomy (TL), and TL plus radioactive iodine (RAI) therapy before and after the 2009 and 2015 ATA guidelines. The secondary objective was to distinguish between institutional and community settings as to which one more influenced variations in practice. From the beginning of the study period to its end, a total of 194,254 individuals were identified (with 155,796 (80.2% of the total) being female patients) with a median [range] age at diagnosis of 51 (18-90) years. The prevalence of TL among surgical patients dropped from 15.1% to 13.7% after the 2009 recommendations but rose to 22.9% after the 2015 revisions. Following the release of the 2009 guidelines and the release of the 2015 guidelines, the rate of adjuvant RAI among TT patients dropped from 48.7% to 37.1% and then to 19.3%, respectively. For both racial and gender-based categories, the overall trends remained consistent. 

The rise in TL rates was greater in research hospitals (from 16.3% to 19.5%) than in community hospitals (from 14.9% to 25.7%). Tumors between 1 and 2 centimeters (between 6.8% and 18.9%) and 2 to 4 centimeters (between 6.6% and 16.0%) showed higher increases in TL rates than tumors under 1 centimeter (between 22.8% and 29.2%). Changes to ATA guidelines were associated with higher TL and lower use of adjuvant radioactive iodine in this cohort study of patients with papillary thyroid carcinomas up to 4 cm. These shifts have largely occurred in universities, which may indicate an opening for expanding guideline-based care in the wider community.

Source: jamanetwork.com/journals/jamaotolaryngology/article-abstract/2798254