title: Optimal treatment strategy in patients with papillary thyroid cancer: a decision analysis.
abstract: BACKGROUND
  The management of patients with papillary thyroid carcinoma (PTC) remains controversial. We used decision analysis to identify the optimal treatment strategy for patients with PTC, stratified by risk-group classification.
  
  
  METHODS
  We designed a Markov model to compare thyroid lobectomy and total thyroidectomy (with adjuvant radioiodine therapy) in low- and high-risk patients with PTC. Morbidity, recurrence, and mortality estimates were obtained from the literature. Outcomes were quality-adjusted by using health state preferences.
  
  
  RESULTS
  In low-risk patients, lobectomy and total thyroidectomy resulted in 31.7 and 32.9 quality-adjusted life years (QALYs). Total thyroidectomy was the optimal strategy as long as the relative risk of recurrence after lobectomy was greater than 1.3. Lobectomy became the preferred strategy if subjects were willing to give up 1.5 years of life to avoid thyroid hormone dependency and a remote risk of radioiodine-induced malignancy. In high-risk patients, lobectomy and total thyroidectomy resulted in 11.2 and 16.5 QALYs. Model results were robust to varying the permanent complication rates of initial or completion thyroidectomy, the efficacy of adjuvant radioiodine therapy, and the impact of complications and cancer recurrence on quality of life, irrespective of risk-group classification.
  
  
  CONCLUSIONS
  Total thyroidectomy maximized quality-adjusted life expectancy in low- and high-risk patients with PTC.
authors.affiliation: Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Tex. 77030-4009, USA.
authors.forename: N F
authors.initials: NF
authors.lastname: Esnaola
authors.forename: S B
authors.initials: SB
authors.lastname: Cantor
authors.forename: S I
authors.initials: SI
authors.lastname: Sherman
authors.forename: J E
authors.initials: JE
authors.lastname: Lee
authors.forename: D B
authors.initials: DB
authors.lastname: Evans
mesh_terms: D002291:Carcinoma, Papillary / Q000601:surgery*; D003661:Decision Support Techniques; D006801:Humans; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*