title: Is There Justification for Total Thyroidectomy in Low-Risk Papillary Thyroid Carcinoma? A Decision-Analysis Model.
abstract: BACKGROUND
  Low-risk papillary thyroid carcinoma is commonly treated surgically. However, uncertainties exist in regard to the optimal extent of surgery. We approached this question using a decision-analysis model.
  
  
  METHODS
  A Markov model was used to compare outcome between patients with small (1-2 cm) low-risk PTC treated by hemithyroidectomy or total thyroidectomy. Probabilities and utilities were derived from the literature. The model was evaluated with Monte Carlo simulation. Sensitivity analysis was used to determine which variables most affected the model.
  
  
  RESULTS
  Hemithyroidectomy was associated with a minor increase in mortality risk. After incorporation of mortality risk, complications, and quality-of-life measures, hemithyroidectomy was found to be superior to total thyroidectomy, with an increasing benefit over time. Quality-of-life measures, especially disutility of disease recurrence and undergoing surgery, had the greatest effect on the incremental benefit of hemithyroidectomy.
  
  
  CONCLUSIONS
  Based on our decision-analysis model, hemithyroidectomy is the preferred option in low-risk PTC.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, 39 Jabotinski Street, 49100, Petach Tikva, Israel. stern_sagit@hotmail.com.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. stern_sagit@hotmail.com.
authors.forename: Sagit
authors.initials: S
authors.lastname: Stern
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, 39 Jabotinski Street, 49100, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Ohad
authors.initials: O
authors.lastname: Hilly
authors.affiliation: Israeli Center for Technology Assessment in Health Care, The Gertner Institute, Tel Hashomer, Ramat Gan, Israel.
authors.forename: Einav
authors.initials: E
authors.lastname: Horowitz
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.|Faculty of Management, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Moshe
authors.initials: M
authors.lastname: Leshno
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rabin Medical Center, 39 Jabotinski Street, 49100, Petach Tikva, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Raphael
authors.initials: R
authors.lastname: Feinmesser
mesh_terms: D000293:Adolescent; D000328:Adult; D002277:Carcinoma / Q000601:surgery*; D002291:Carcinoma, Papillary; D003661:Decision Support Techniques; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D008962:Models, Theoretical; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D055815:Young Adult