A study determines that implementation of the 2015 American Thyroid Association guidelines on surgery for well-differentiated thyroid carcinoma was associated with a significant decrease in the rates of both up-front total thyroidectomy and completion thyroidectomy. The study was published in JAMA Otolaryngology-Head & Neck Surgery.

The purpose of this study was to evaluate clinical practice changes associated with the implementation of the updated guidelines on the surgical procedure rates of total thyroidectomy, thyroid lobectomy, and completion thyroidectomy at a single tertiary medical center.

The recommended extent of surgery for well-differentiated thyroid carcinoma has been modified considerably in the updated 2015 American Thyroid Association guidelines published in January 2016. To date, the changes in clinical practice after the publication of these new guidelines have not been demonstrated.

Researchers performed a retrospective cohort study of 169 patients to evaluate clinical practice changes associated with the implementation of the updated guidelines on the surgical procedure rates of total thyroidectomy, thyroid lobectomy, and completion thyroidectomy at a single tertiary medical center.

Primary outcomes were the rate of up-front total thyroidectomy vs. lobectomy and the rates of completion thyroidectomy before and after the implementation of the new guidelines. The researchers found that up-front total thyroidectomy was performed in 61% of patients before the 2015 American Thyroid Association guidelines were implemented and in 31.4% after guideline implementation.

There was also a significant decrease in the rate of completion thyroidectomy between these periods (73.9 versus 20 percent; OR, 0.09). "The extent of thyroidectomy was reduced considerably following the 2015 American Thyroid Association guidelines, and only one of five patients who undergo thyroid lobectomy will require a completion procedure according to the new criteria," the authors write.

Of the 169 patients, in the final analysis, 118 (69.8%) were included from 2013 to 2014 and 51 (30.2%) in 2016. The mean (SD) age for the entire cohort was 44 (13.8) years, and 129 (76.3%) were women. Up-front total thyroidectomy was performed in 72 of 118 patients (61.0%) before the 2015 American Thyroid Association guidelines and 16 of 51 (31.4%) following their implementation (odds ratio, 0.29; 95% CI, 0.14-0.59).

The updated 2015 American Thyroid Association guidelines implementation was associated with a significant decrease in the rates of both up-front total thyroidectomy and completion thyroidectomy. According to these findings, only 1 of 5 patients who undergo thyroid lobectomy will require a completion procedure.