title: Initial therapy with either thyroid lobectomy or total thyroidectomy without radioactive iodine remnant ablation is associated with very low rates of structural disease recurrence in properly selected patients with differentiated thyroid cancer.
abstract: OBJECTIVE
  To describe the risk of structural disease recurrence in a cohort of patients with differentiated thyroid cancer selected for treatment with either thyroid lobectomy or total thyroidectomy without radioactive iodine remnant ablation (RRA).
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  A total of 289 patients were selected for either thyroid lobectomy (n = 72) or total thyroidectomy (n = 217) without RRA and followed with modern disease detection tools in a tertiary referral centre. Most patients had papillary thyroid cancer (89%) without clinically evident lymph node metastases (91%). However, 55% (156/289) of patients had primary tumours that were >1 cm and 10% (28/289) had minor extrathyroidal extension.
  
  
  METHODS
  The primary endpoint was detection of recurrent/persistent structural disease.
  
  
  RESULTS
  After a 5-year median follow-up, structural disease recurrence was detected in 2·3% (5/217) of patients treated with total thyroidectomy without RRA, and in 4·2% (3/72) of patients treated with thyroid lobectomy. Size of the primary tumour, the presence of cervical lymph node metastases and American Thyroid Association risk category were all statistically significant predictors of recurrence. Changes in serum thyroglobulin were not helpful in identifying the presence of persistent/recurrent structural disease. Importantly, 88% (7/8) of the patients that had recurrent disease were rendered clinically disease free with additional therapies.
  
  
  CONCLUSIONS
  Initial risk stratification is able to identify a cohort of patients with differentiated thyroid cancer with a very low risk of structural disease recurrence following treatment with either thyroid lobectomy or total thyroidectomy without RRA. Our data strongly support a selective approach to the initial management of thyroid cancer.
authors.affiliation: Endocrinology Service, Head and Neck Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USAEndocrinology Service, Universidade Federal do Rio de Janeiro and Instituto Nacional do Cancer, Rio de Janeiro, Brazil.
authors.forename: F
authors.initials: F
authors.lastname: Vaisman
authors.forename: A
authors.initials: A
authors.lastname: Shaha
authors.forename: S
authors.initials: S
authors.lastname: Fish
authors.forename: R
authors.initials: R
authors.lastname: Michael Tuttle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013507:Endocrine Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D011379:Prognosis; D012306:Risk; D013964:Thyroid Neoplasms / Q000145:classification / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult