Endocrine Abstracts

Often discovered incidentally, small foci (≤2 cm) of papillary thyroid carcinomas (PTC) are its most frequent presentation. Despite favourable prognosis, the extent of surgery and use of radioablation is still controversial.

Objective: Prospective cohort study of all patients admitted between 2007 and 2011, for thyroid surgery in the Institute of Endocrinology, Bucharest, Romania, and had pT1a or pT1b PTC.

Patients and methods: We identified 109 patients who fulfilled the criteria (92 women and 17 men), aged 46.63±13.81 years. In most patients PTC was discovered incidentally after thyroid surgery; only 20.7% had previous suspicious FNAB. In 87.21%, total thyroidectomy was performed per primam; 16 patients had initial partial thyroidectomy and later completion thyroidectomy. Tumour diameter was 0.77±0.59 cm; 70.64% were T1a and 33.94% were multifocal (additional foci found in 9/16 patients with completion thyroidectomy). After surgery the patients were followed-up with serial ultrasound and stimulated thyroglobulin (STgl).

Results: Post-op STgl was 1.94±3.39 ng/ml; 71 (68.27%) had STgl levels <2 ng/ml, while in 33 (31.73%), STgl≥2 ng/ml (range, 2–28.4). Radioablation was performed in 61 patients: 44.16% T1a vs 84.37% T1b, P=0.0001. The total dose was significantly higher for patients treated between 2007 and 2009 vs 2010 and 2011: 110.33±43.85 vs 75.87±36.22 mCi, P=0.01. Whole body scan was performed in 56/109 patients, being positive in 2 (3.56%). At the end of follow-up (23.90±14.13 months), ultrasound showed small thyroid remnants in 8.42%. The last STgl levels were<2 ng/ml in 74 (74.7%) patients, with no significant differences T1a vs T1b or multicentric vs unicentric PTC. The rest had higher STgl levels (range, 2–10.16 ng/ml) probably due to thyroid remnants/low volume residual tumour. Lower STgl levels (P=NS) were noted in radioablated vs nonablated patients (0.33±0.32 vs 2.23±3.24 ng/ml).

Conclusion: Small PTC often has an excellent prognosis. For un-ablated patients, a long term follow-up is required for the STgl trend to reveal recurrences and allow appropriate management.