Natural History of Contralateral Nodules after Lobectomy in Patients with Papillary Thyroid Carcinoma.

Natural History of Contralateral Nodules after Lobectomy in Patients with Papillary Thyroid Carcinoma.

J Clin Endocrinol Metab. 2017 Dec 12;:

Authors: Ritter A, Bachar G, Hirsch D, Benbassat C, Katz O, Kochen N, Diker-Cohen T, Akirov A, Shimon I, Robenshtok E

Abstract
Background: Bilateral thyroid nodularity is considered an indication for total thyroidectomy in papillary thyroid carcinoma (PTC) patients. However, the natural history and outcome of contralateral nodules has never been studied.
Objective: To investigate the natural history of non-suspicious contralateral nodules after lobectomy for PTC.
Methods: We included patients who had ≥1 solid nodules (≥3mm) in the contralateral lobe prior to surgery with benign cytology, or small non suspicious nodules per ultrasound.
Results: One hundred and twelve patients were included. Median age was 57 years, and median size of PTC (initial lobectomy) was 8mm (range 0.5-28). On the contralateral side, the median size of nodules was 7mm (range 3-30). Thirty-three nodules (29%) had fine needle aspiration before surgery, and all were benign. After median follow-up of 6 years, median growth was zero (range -20-19mm). Twenty-six nodules (23%) increased in size ≥3mm (median 6mm, range 4-19mm). Twenty patients (18%) developed new nodules. Twelve patients (11%) underwent completion thyroidectomy for: growth (3), suspicious FNA (7, Bethesda III-V), malignancy (1), or unknown reason (1). Overall, based on the completion thyroidectomy specimen, 6 patients (5%) were diagnosed with contralateral PTC (5 micro-PTC, one 20mm), and are all without evidence of disease at the end of follow-up. There were no surgical difficulties or local complications during completion surgery.
Conclusions: Lobectomy for low risk patients with small PTC and contralateral non-suspicious thyroid nodule/s is a reliable and safe initial treatment option. In the few patients who required completion thyroidectomy, treatment with surgery and radioiodine was effective.

PMID: 29240898 [PubMed - as supplied by publisher]

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