Current trends in TSH suppression therapy for patients with papillary thyroid carcinoma in Japan: results of a questionnaire distributed to councilors of the Japanese Society of Thyroid Surgery

The prognostic value of serum thyroid-stimulating hormone level post-lobectomy in low- and intermediate-risk papillary thyroid carcinoma

BACKGROUND

This study was undertaken to determine the optimal thyroid-stimulating hormone (TSH) value associated with structural recurrence in patients with low-risk or intermediate-risk papillary thyroid carcinoma (PTC) who underwent thyroid lobectomy.

METHODS

Patients with PTC (n = 1047) who received thyroid lobectomy and central compartment node dissection were included in the study.

RESULTS

Structural recurrence occurred in 42 of the patients (4.0%), and no patient died of PTC. Multivariate analysis showed a primary tumor size (with a cut-off of 0.85 cm) and serum TSH level measured 1 year after the initial surgery (cut-off 1.85 mU/L) independently predicted structural recurrence.

CONCLUSIONS

TSH levels during the early postoperative period need to be monitored and maintained in the lower normal range even in patients with low- or intermediate-risk PTC undergoing thyroid lobectomy.

Treatment related morbidity in differentiated thyroid cancer-a survey of clinicians

Abstracts

Controversies in primary treatment of low-risk papillary thyroid cancer

In many parts of the world, incidence of papillary thyroid cancer is increasing faster than any other malignancy. Most papillary thyroid cancers that are diagnosed are small and are generally regarded as being low risk, with little or no effect on mortality. Papillary thyroid cancer is a clinical challenge because it is difficult to prove benefit from the traditional therapeutic triad for this disorder (ie, total thyroidectomy with or without prophylactic central neck dissection, radioiodine remnant ablation, and suppression of serum thyroid-stimulating hormone with levothyroxine). However, risk of disease recurrence might be reduced by these therapies in a subset of patients with more aggressive disease. In the past decade, professional societies and other groups have established evidence-based clinical practice guidelines for management of papillary thyroid cancer, but these efforts have been made difficult by a paucity of randomised controlled trials. In this review, we summarise epidemiological data for disease incidence, discuss some controversies in disease management, and outline a therapeutic framework founded in the best available medical evidence and existing recommendations from clinical practice guidelines.