Endocrine Abstracts

Thyroid cancer is the commonest malignancy seen in endocrine practice. Audits of clinical practice have revealed significant variations in management, and the British Thyroid Association have published guidelines (2002) to address this. The aim of our study was to assess the care-stage at which practice falls short of agreed standards. We performed retrospective case note review of 83 patients (72 female) followed in a specialist thyroid cancer clinic over 5 years. Histology distribution was as expected: 50 had papillary, 29 follicular, 2 anaplastic and 2 medullary carcinoma. Only 66 (82.5%) patients had cytology preoperatively. 80 patients had thyroid surgery. 54 had tumour size >1 cm: 53 underwent total thyroidectomy and 1 lobectomy, 51 (94.4%) had radioiodine therapy, and all 54 received TSH-suppressive therapy. 26 patients with tumour size <1 cm, eight (30.8%) had lobectomy alone (6 for micro-carcinoma), and 1 received TSH-suppressive therapy. 9 patients out of 80 had lymph node dissection recommended by the guidelines. After surgery 5 (6.3%) patients had impaired vocal cord function and 9 (11.3%) had hypocalcaemia (<2.00 mmol/l), all remaining on calcium treatment 1 year later. At first post-surgery follow-up only 61 (76.3%) patients had thyroid function, 32 (40%) calcium and 29 (36.3%) thyroglobulin measured. For all patients subsequent management was undertaken in a specialist thyroid cancer clinic, where this monitoring is routine. At last review 75 patients were disease-free, 1 has recurrent disease, 5 were dead from thyroid disease and 2 from other causes.

This study shows that some guideline standards are not achieved; lymph-node sampling is not being performed as recommended, and pre- and post-operative laboratory assessment is incomplete. These observations indicate that closer adherence to guidelines is needed in the surgical stage of treatment, and that the provision of a specialist thyroid cancer clinic is not sufficient to ensure ideal care.