Endocrine Abstracts

Background: Since 2006 according to the European consensus for the management of patients with DTC, in tumors ≤ 1 cm, treatment with thyroidectomy alone without ¹³¹I treatment was suggested. Therefore, in our institution, we applied this suggestion in clinical practice, although prospective studies were not still available. Aim of this study is to evaluate the rate of the events occurring in a medium-long term follow-up.

Patients and Methods: We evaluated clinical-pathologic data of 378 consecutive DTC patients at low risk of recurrence treated with total thyroidectomy, without lymph node dissection and ¹³¹I treatment after surgery, between 2006 and 2012. Events during the follow-up were defined as structural if abnormal findings at neck US appeared and were cytologically confirmed. Biologic events were defined in TgAb negative patients if LT4-Tg increased >5 ng/ml or >2 ng/ml in two consecutive evaluations, or TgAb appeared; conversely in TgAb positive patients if TgAb increased > 50% in two consecutive evaluations and if the increasing trend over time was constant.

Results: Females accounted for 75.4% of our study group median age was 50 (IQR 40.75-59). Mean tumor size was 0.45±0.27 cm. Most of patients had a unifocal T1a tumor (98.9%), and 73.3% had CV-PTC, 24.1% FV-PTC, 2.4% aggressive variants of PTC and in 1 case an FTC was diagnosed. After a median follow-up of 7.7 years, no structural events occurred. Regarding biologic events, 16/378 (4.2%) were highlighted, 12 (3.2%) for increase in LT4-Tg values and 4 (1.1%) for the increase in TgAb values, over time. Mean detection time of biologic events was 41 months (median 17 months). No patients performed additional treatments, surgery or ¹³¹I treatment and currently were followed-up with active surveillance.

Conclusions: In a real-life experience in the management of low-risk DTC we obtained similar results than the recently reported prospective ESTIMABL2 trial, although with a mean tumor size slightly smaller, but in longer follow-up time. These data confirmed that also in a medium-long term follow-up, low-risk DTC, particularly PTC, treated with total thyroidectomy without ¹³¹I treatment showed an excellent outcome, without any additional treatment performed over time.