Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Thyroid surgery for differentiated thyroid cancer — recent advances and future directions

Nature Reviews Endocrinology volume 14, pages 670–683 (2018)Cite this article

Subjects

Abstract

Population-based studies have demonstrated that an increasing number of incidental thyroid nodules are being identified. The corresponding increase in thyroid-based diagnostic procedures, such as fine-needle aspiration biopsy, has in part led to an increase in the diagnoses of thyroid cancers and to more thyroid surgeries being performed. Small papillary thyroid cancers account for most of this increase in diagnoses. These cancers are considered to be low risk because of the excellent patient outcomes, with a 5-year disease-specific survival of >98%. As a result, controversy remains regarding the optimal management of newly diagnosed differentiated thyroid cancer, as the complications related to thyroidectomy (primarily recurrent laryngeal nerve injury and hypoparathyroidism) have considerable effects on patient quality of life. This Review highlights current debates, including undertaking active surveillance versus thyroid surgery for papillary thyroid microcarcinoma, the extent of thyroid surgery and lymphadenectomy for low-risk differentiated thyroid cancer, and the use of molecular testing to guide decision-making about whether surgery is required and the extent of the initial operation. This Review includes a discussion of current consensus guideline recommendations regarding these topics in patients with differentiated thyroid cancer. Additionally, innovative thyroidectomy techniques (including robotic and transoral approaches) are discussed, with an emphasis on patient preferences around decision-making and outcomes following thyroidectomy.

Key points

  • The incidence of thyroid cancer is increasing across the United States; this includes thyroid cancers of all tumour sizes and stages.

  • Molecular testing for indeterminate thyroid nodules continues to evolve and guide recommendations for the extent of thyroid surgery.

  • Appropriate extent of thyroidectomy for patients with low-risk thyroid cancer remains dynamic and might include active surveillance, thyroid lobectomy or total thyroidectomy.

  • Given the excellent outcomes for most patients with differentiated thyroid cancer, patient preference and a robust discussion regarding options for the extent of surgery and long-term surveillance are critical.

  • A strong association exists between surgeon volume and patient outcomes; surgeons’ awareness of their own outcomes is critical.

  • Referring providers, payers and policymakers should be aware of the implications of the association between surgeon volume and patient outcomes so that patient access to experienced thyroid surgeons can be optimized.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Trends in annual incidence rates for papillary thyroid cancer.
Fig. 2: Risk of structural disease recurrence after initial therapy.
Fig. 3: Lymph node levels of the central and lateral compartments of the neck.
Fig. 4: Smoothed restricted cubic spline plot of the adjusted log odds ratio of experiencing any complication versus the number of total thyroidectomies performed per surgeon per year in the Health Care Utilization Project – National Inpatient Sample.

Similar content being viewed by others

References

  1. Davies, L. & Welch, H. G. Current thyroid cancer trends in the United States. JAMA Otolaryngol. Head Neck Surg. 140, 317–322 (2014).

    PubMed  Google Scholar 

  2. Kitahara, C. M. & Sosa, J. A. The changing incidence of thyroid cancer. Nat. Rev. Endocrinol. 12, 646–653 (2016).

    PubMed  Google Scholar 

  3. Davies, L. et al. American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: the increasing incidence of thyroid cancer. Endocr. Pract. 21, 686–696 (2015).

    PubMed  PubMed Central  Google Scholar 

  4. Cabanillas, M. E., McFadden, D. G. & Durante, C. Thyroid cancer. Lancet 388, 2783–2795 (2016).

    CAS  PubMed  Google Scholar 

  5. Lubitz, C. C. & Sosa, J. A. The changing landscape of papillary thyroid cancer: epidemiology, management, and the implications for patients. Cancer 122, 3754–3759 (2016).

    PubMed  Google Scholar 

  6. Sosa, J. A., Hanna, J. W., Robinson, K. A. & Lanman, R. B. Increases in thyroid nodule fine-needle aspirations, operations, and diagnoses of thyroid cancer in the United States. Surgery 154, 1420–1426; discussion 1426–1427 (2013).

    PubMed  Google Scholar 

  7. Kent, W. D. et al. Increased incidence of differentiated thyroid carcinoma and detection of subclinical disease. CMAJ 177, 1357–1136 (2007).

    PubMed  PubMed Central  Google Scholar 

  8. Enewold, L. et al. Rising thyroid cancer incidence in the United States by demographic and tumor characteristics, 1980–2005. Cancer Epidemiol. Biomarkers Prev. 18, 784–791 (2009).

    PubMed  PubMed Central  Google Scholar 

  9. Tuttle, R. M. et al. in AJCC Cancer Staging Manual 8th edn Ch. 73 (ed. Amin, M. B.) 873–890 (Springer Nature, 2017).

  10. Tuttle, R. M., Haugen, B. & Perrier, N. D. Updated American Joint Committee on cancer/tumor-node-metastasis staging system for differentiated and anaplastic thyroid cancer (eighth edition): what changed and why? Thyroid 27, 751–756 (2017).

    PubMed  PubMed Central  Google Scholar 

  11. Cibas, E. S. & Ali, S. Z. The Bethesda system for reporting thyroid cytopathology. Thyroid 19, 1159–1165 (2009).

    PubMed  Google Scholar 

  12. Cibas, E. S. & Ali, S. Z. The 2017 Bethesda system for reporting thyroid cytopathology. Thyroid 27, 1341–1346 (2017).

    PubMed  Google Scholar 

  13. Haugen, B. R. et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer. Thyroid 26, 1–133 (2016).

    PubMed  PubMed Central  Google Scholar 

  14. Ferris, R. L. et al. American Thyroid Association statement on surgical application of molecular profiling for thyroid nodules: current impact on perioperative decision Making. Thyroid 25, 760–768 (2015).

    PubMed  PubMed Central  Google Scholar 

  15. Yip, L. & Sosa, J. A. Molecular-directed treatment of differentiated thyroid cancer: advances in diagnosis and treatment. JAMA Surg. 151, 663–670 (2016).

    PubMed  Google Scholar 

  16. Nikiforov, Y. E. Role of molecular markers in thyroid nodule management: then and now. Endocr. Pract. 23, 979–988 (2017).

    PubMed  Google Scholar 

  17. McIver, B. et al. An independent study of a gene expression classifier (Afirma) in the evaluation of cytologically indeterminate thyroid nodules. J. Clin. Endocrinol. Metab. 99, 4069–4077 (2014).

    CAS  PubMed  Google Scholar 

  18. Harrison, G., Sosa, J. A. & Jiang, X. Evaluation of the Afirma gene expression classifier in repeat indeterminate thyroid nodules. Arch. Pathol. Lab Med. 141, 985–989 (2017).

    PubMed  Google Scholar 

  19. Alexander, E. K. et al. Preoperative diagnosis of benign thyroid nodules with indeterminate cytology. N. Engl. J. Med. 367, 705–715 (2012).

    CAS  PubMed  Google Scholar 

  20. Duh, Q. Y., Busaidy, N. L., Rahilly-Tierney, C., Gharib, H. & Randolph, G. A. Systematic review of the methods of diagnostic accuracy studies of the Afirma gene expression classifier. Thyroid 27, 1215–1222 (2017).

    PubMed  Google Scholar 

  21. Valderrabano, P. et al. Institutional prevalence of malignancy of indeterminate thyroid cytology is necessary but insufficient to accurately interpret molecular marker tests. Eur. J. Endocrinol. 174, 621–629 (2016).

    PubMed  Google Scholar 

  22. Marti, J. L. et al. Wide inter-institutional variation in performance of a molecular classifier for indeterminate thyroid nodules. Ann. Surg. Oncol. 22, 3996–4001 (2015).

    PubMed  PubMed Central  Google Scholar 

  23. Harrell, R. M. & Bimston, D. N. Surgical utility of Afirma: effects of high cancer prevalence and oncocytic cell types in patients with indeterminate thyroid cytology. Endocr. Pract. 20, 364–369 (2014).

    PubMed  Google Scholar 

  24. Cancer Genome Atlas Research, N. Integrated genomic characterization of papillary thyroid carcinoma. Cell 159, 676–690 (2014).

    Google Scholar 

  25. Steward, D. et al. Clinical validation of Thyroseq V3 performance in thyroid nodules with indeterminate cytology: a prospective blinded multi-institutional validation study. Thyroid 27, A167 (2017).

    Google Scholar 

  26. Brauner, E. et al. Performance of the Afirma gene expression classifier in Hurthle cell thyroid nodules differs from other indeterminate thyroid nodules. Thyroid 25, 789–796 (2015).

    PubMed  Google Scholar 

  27. Duh, Q. Y. et al. Development and validation of classifiers to enhance the Afirma genomic sequencing classifier performance among Hurthle cell specimens. Thyroid 27, A168 (2017).

    Google Scholar 

  28. Strickland, K. C. et al. Preoperative cytologic diagnosis of noninvasive follicular thyroid neoplasm with papillary-like nuclear features: a prospective analysis. Thyroid 26, 1466–1471 (2016).

    PubMed  Google Scholar 

  29. Sahli, Z. T., Umbricht, C. B., Schneider, E. B. & Zeiger, M. A. Thyroid nodule diagnostic markers in the face of the new NIFTP category: time for a reset? Thyroid 27, 1393–1399 (2017).

    PubMed  Google Scholar 

  30. Balentine, C. J., Vanness, D. J. & Schneider, D. F. Cost-effectiveness of lobectomy versus genetic testing (Afirma(R)) for indeterminate thyroid nodules: considering the costs of surveillance. Surgery 163, 88–96 (2018).

    PubMed  Google Scholar 

  31. Yip, L. et al. Cost impact of molecular testing for indeterminate thyroid nodule fine-needle aspiration biopsies. J. Clin. Endocrinol. Metab. 97, 1905–1912 (2012).

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Carneiro-Pla, D. et al. Feasibility of surgeon-performed transcutaneous vocal cord ultrasonography in identifying vocal cord mobility: a multi-institutional experience. Surgery 156, 1597–1602; discussion 1602–1594 (2014).

    PubMed  Google Scholar 

  33. Chandrasekhar, S. S. et al. Clinical practice guideline: improving voice outcomes after thyroid surgery. Otolaryngol. Head Neck Surg. 148, S1–S37 (2013).

    PubMed  Google Scholar 

  34. Renkema, K. Y., Alexander, R. T., Bindels, R. J. & Hoenderop, J. G. Calcium and phosphate homeostasis: concerted interplay of new regulators. Ann. Med. 40, 82–91 (2008).

    CAS  PubMed  Google Scholar 

  35. Holick, M. F. Vitamin D deficiency. N. Engl. J. Med. 357, 266–281 (2007).

    CAS  PubMed  Google Scholar 

  36. Momesso, D. P. et al. Dynamic risk stratification in patients with differentiated thyroid cancer treated without radioactive iodine. J. Clin. Endocrinol. Metab. 101, 2692–2700 (2016).

    CAS  PubMed  Google Scholar 

  37. Yeh, M. W. et al. American Thyroid Association statement on preoperative imaging for thyroid cancer surgery. Thyroid 25, 3–14 (2015).

    PubMed  PubMed Central  Google Scholar 

  38. American Thyroid Association Surgery Working, G. et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid 19, 1153–1158 (2009).

    Google Scholar 

  39. National Comprehensive Cancer Network. Thyroid Carcinoma Version 2. May 2017 https://www.nccn.org/professionals/physician_gls/default.aspx (2017).

  40. Padovani, R. P. et al. One month is sufficient for urinary iodine to return to its baseline value after the use of water-soluble iodinated contrast agents in post-thyroidectomy patients requiring radioiodine therapy. Thyroid 22, 926–930 (2012).

    CAS  PubMed  PubMed Central  Google Scholar 

  41. Sohn, S. Y. et al. The impact of iodinated contrast agent administered during preoperative computed tomography scan on body iodine pool in patients with differentiated thyroid cancer preparing for radioactive iodine treatment. Thyroid 24, 872–877 (2014).

    CAS  PubMed  Google Scholar 

  42. Hay, I. D. et al. Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period. Surgery 144, 980–987; discussion 987–988 (2008).

    PubMed  Google Scholar 

  43. Ito, Y. et al. An observational trial for papillary thyroid microcarcinoma in Japanese patients. World J. Surg. 34, 28–35 (2010).

    PubMed  Google Scholar 

  44. Baudin, E. et al. Microcarcinoma of the thyroid gland: the Gustave-Roussy Institute experience. Cancer 83, 553–559 (1998).

    CAS  PubMed  Google Scholar 

  45. Wang, T. S., Goffredo, P., Sosa, J. A. & Roman, S. A. Papillary thyroid microcarcinoma: an over-treated malignancy? World J. Surg. 38, 2297–2303 (2014).

    PubMed  Google Scholar 

  46. Ito, Y. et al. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid 24, 27–34 (2014).

    CAS  PubMed  PubMed Central  Google Scholar 

  47. Bilimoria, K. Y. et al. Extent of surgery affects survival for papillary thyroid cancer. Ann. Surg. 246, 375–381; discussion 381–374 (2007).

    PubMed  PubMed Central  Google Scholar 

  48. Haigh, P. I., Urbach, D. R. & Rotstein, L. E. Extent of thyroidectomy is not a major determinant of survival in low- or high-risk papillary thyroid cancer. Ann. Surg. Oncol. 12, 81–89 (2005).

    PubMed  Google Scholar 

  49. Barney, B. M., Hitchcock, Y. J., Sharma, P., Shrieve, D. C. & Tward, J. D. Overall and cause-specific survival for patients undergoing lobectomy, near-total, or total thyroidectomy for differentiated thyroid cancer. Head Neck 33, 645–649 (2011).

    PubMed  Google Scholar 

  50. Mendelsohn, A. H., Elashoff, D. A., Abemayor, E. & St John, M. A. Surgery for papillary thyroid carcinoma: is lobectomy enough? Arch. Otolaryngol. Head Neck Surg. 136, 1055–1061 (2010).

    PubMed  Google Scholar 

  51. Nixon, I. J. et al. Thyroid lobectomy for treatment of well differentiated intrathyroid malignancy. Surgery 151, 571–579 (2012).

    PubMed  Google Scholar 

  52. Adam, M. A. et al. Impact of extent of surgery on survival for papillary thyroid cancer patients younger than 45 years. J. Clin. Endocrinol. Metab. 100, 115–121 (2015).

    CAS  PubMed  Google Scholar 

  53. Adam, M. A. et al. Extent of surgery for papillary thyroid cancer is not associated with survival: an analysis of 61,775 patients. Ann. Surg. 260, 601–605; discussion 605–607 (2014).

    PubMed  PubMed Central  Google Scholar 

  54. Tuttle, R. M. et al. Natural history and tumor volume kinetics of papillary thyroid cancers during active surveillance. JAMA Otolaryngol. Head Neck Surg. 143, 1015–1020 (2017).

    PubMed  PubMed Central  Google Scholar 

  55. Hughes, D. T. et al. Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer. Surgery 148, 1100–1106; discussion 1006–1107 (2010).

    PubMed  Google Scholar 

  56. Hughes, D. T. & Doherty, G. M. Central neck dissection for papillary thyroid cancer. Cancer Control 18, 83–88 (2011).

    PubMed  Google Scholar 

  57. Adam, M. A. et al. Exploring the relationship between patient age and cancer-specific survival in papillary thyroid cancer: rethinking current staging systems. J. Clin. Oncol. 34, 4415–4420 (2016).

    PubMed  Google Scholar 

  58. Lang, B. H. et al. A systematic review and meta-analysis of prophylactic central neck dissection on short-term locoregional recurrence in papillary thyroid carcinoma after total thyroidectomy. Thyroid 23, 1087–1098 (2013).

    PubMed  Google Scholar 

  59. Viola, D. et al. Prophylactic central compartment lymph node dissection in papillary thyroid carcinoma: clinical implications derived from the first prospective randomized controlled single institution study. J. Clin. Endocrinol. Metab. 100, 1316–1324 (2015).

    CAS  Google Scholar 

  60. Wang, T. S., Cheung, K., Farrokhyar, F., Roman, S. A. & Sosa, J. A. A meta-analysis of the effect of prophylactic central compartment neck dissection on locoregional recurrence rates in patients with papillary thyroid cancer. Ann. Surg. Oncol. 20, 3477–3483 (2013).

    PubMed  Google Scholar 

  61. Wang, T. S., Evans, D. B., Fareau, G. G., Carroll, T. & Yen, T. W. Effect of prophylactic central compartment neck dissection on serum thyroglobulin and recommendations for adjuvant radioactive iodine in patients with differentiated thyroid cancer. Ann. Surg. Oncol. 19, 4217–4222 (2012).

    PubMed  Google Scholar 

  62. Carling, T. et al. American Thyroid Association design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma. Thyroid 22, 237–244 (2012).

    PubMed  Google Scholar 

  63. American Thyroid Association Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19, 1167–1214 (2009).

    Google Scholar 

  64. Cooper, D. S. et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 16, 109–142 (2006).

    PubMed  Google Scholar 

  65. Schneider, D. F., Chen, H. & Sippel, R. S. Impact of lymph node ratio on survival in papillary thyroid cancer. Ann. Surg. Oncol. 20, 1906–1911 (2013).

    PubMed  Google Scholar 

  66. Robinson, T. J. et al. How many lymph nodes are enough? Assessing the adequacy of lymph node yield for papillary thyroid cancer. J. Clin. Oncol. 34, 3434–3439 (2016).

    PubMed  Google Scholar 

  67. Jiang, Z. G. et al. Clinical benefits of scarless endoscopic thyroidectomy: an expert’s experience. World J. Surg. 35, 553–557 (2011).

    PubMed  Google Scholar 

  68. Wilhelm, T. & Metzig, A. Endoscopic minimally invasive thyroidectomy (eMIT): a prospective proof-of-concept study in humans. World J. Surg. 35, 543–551 (2011).

    PubMed  Google Scholar 

  69. Anuwong, A. Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases. World J. Surg. 40, 491–497 (2016).

    PubMed  Google Scholar 

  70. Kandil, E. H., Noureldine, S. I., Yao, L. & Slakey, D. P. Robotic transaxillary thyroidectomy: an examination of the first one hundred cases. J. Am. Coll. Surg. 214, 558–564; discussion 564–556 (2012).

    PubMed  Google Scholar 

  71. Duke, W. S. et al. Remote access robotic facelift thyroidectomy: a multi-institutional experience. World J. Surg. 41, 116–121 (2017).

    PubMed  Google Scholar 

  72. Lee, J., Kwon, I. S., Bae, E. H. & Chung, W. Y. Comparative analysis of oncological outcomes and quality of life after robotic versus conventional open thyroidectomy with modified radical neck dissection in patients with papillary thyroid carcinoma and lateral neck node metastases. J. Clin. Endocrinol. Metab. 98, 2701–2708 (2013).

    CAS  PubMed  Google Scholar 

  73. Kim, M. J. et al. Yonsei Experience of 5000 gasless transaxillary robotic thyroidectomies. World J. Surg. 42, 393–401 (2018).

    PubMed  Google Scholar 

  74. Berber, E. et al. American Thyroid Association statement on remote-access thyroid surgery. Thyroid 26, 331–337 (2016).

    PubMed  PubMed Central  Google Scholar 

  75. Lang, B. H., Wong, C. K., Tsang, J. S., Wong, K. P. & Wan, K. Y. A systematic review and meta-analysis comparing surgically-related complications between robotic-assisted thyroidectomy and conventional open thyroidectomy. Ann. Surg. Oncol. 21, 850–861 (2014).

    PubMed  Google Scholar 

  76. Adam, M. A. et al. Robotic thyroidectomy for cancer in the US: patterns of use and short-term outcomes. Ann. Surg. Oncol. 21, 3859–3864 (2014).

    PubMed  PubMed Central  Google Scholar 

  77. Anuwong, A., Kim, H. Y. & Dionigi, G. Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences. Gland Surg. 6, 277–284 (2017).

    PubMed  PubMed Central  Google Scholar 

  78. Chung, T. K. et al. Examining national outcomes after thyroidectomy with nerve monitoring. J. Am. Coll. Surg. 219, 765–770 (2014).

    PubMed  PubMed Central  Google Scholar 

  79. Dralle, H. et al. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J. Surg. 32, 1358–1366 (2008).

    CAS  PubMed  Google Scholar 

  80. Brajcich, B. C. & McHenry, C. R. The utility of intraoperative nerve monitoring during thyroid surgery. J. Surg. Res. 204, 29–33 (2016).

    PubMed  Google Scholar 

  81. Pisanu, A., Porceddu, G., Podda, M., Cois, A. & Uccheddu, A. Systematic review with meta-analysis of studies comparing intraoperative neuromonitoring of recurrent laryngeal nerves versus visualization alone during thyroidectomy. J. Surg. Res. 188, 152–161 (2014).

    PubMed  Google Scholar 

  82. Barczynski, M., Konturek, A. & Cichon, S. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br. J. Surg. 96, 240–246 (2009).

    CAS  PubMed  Google Scholar 

  83. Dralle, H. et al. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 136, 1310–1322 (2004).

    PubMed  Google Scholar 

  84. Henry, B. M. et al. The current state of intermittent intraoperative neural monitoring for prevention of recurrent laryngeal nerve injury during thyroidectomy: a PRISMA-compliant systematic review of overlapping meta-analyses. Langenbecks Arch. Surg. 402, 663–673 (2017).

    PubMed  PubMed Central  Google Scholar 

  85. Fundakowski, C. E. et al. Surgical management of the recurrent laryngeal nerve in thyroidectomy: American Head and Neck Society consensus statement. Head Neck 40, 663–675 (2018).

    PubMed  Google Scholar 

  86. Terris, D. J., Chaung, K. & Duke, W. S. Continuous vagal nerve monitoring is dangerous and should not routinely be done during thyroid surgery. World J. Surg. 39, 2471–2476 (2015).

    PubMed  Google Scholar 

  87. Dralle, H. et al. Loss of the nerve monitoring signal during bilateral thyroid surgery. Br. J. Surg. 99, 1089–1095 (2012).

    CAS  PubMed  Google Scholar 

  88. Dionigi, G. & Frattini, F. Staged thyroidectomy: time to consider intraoperative neuromonitoring as standard of care. Thyroid 23, 906–908 (2013).

    PubMed  Google Scholar 

  89. Fontenot, T. E., Randolph, G. W., Setton, T. E., Alsaleh, N. & Kandil, E. Does intraoperative nerve monitoring reliably aid in staging of total thyroidectomies? Laryngoscope 125, 2232–2235 (2015).

    PubMed  Google Scholar 

  90. Al-Qurayshi, Z., Kandil, E. & Randolph, G. W. Cost-effectiveness of intraoperative nerve monitoring in avoidance of bilateral recurrent laryngeal nerve injury in patients undergoing total thyroidectomy. Br. J. Surg. 104, 1523–1531 (2017).

    CAS  PubMed  Google Scholar 

  91. Randolph, G. W. et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope 121 (Suppl. 1), S1–S16 (2011).

    PubMed  Google Scholar 

  92. Barczynski, M. et al. External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International Neural Monitoring Study Group standards guideline statement. Laryngoscope 123 (Suppl. 4), S1–S14 (2013).

    PubMed  Google Scholar 

  93. Terris, D. J. et al. American Thyroid Association statement on outpatient thyroidectomy. Thyroid 23, 1193–1202 (2013).

    PubMed  Google Scholar 

  94. Snyder, S. K. et al. Outpatient thyroidectomy is safe and reasonable: experience with more than 1,000 planned outpatient procedures. J. Am. Coll. Surg. 210, 575–582, 582–574 (2010).

    PubMed  Google Scholar 

  95. Segel, J. M., Duke, W. S., White, J. R., Waller, J. L. & Terris, D. J. Outpatient thyroid surgery: safety of an optimized protocol in more than 1,000 patients. Surgery 159, 518–523 (2016).

    PubMed  Google Scholar 

  96. Begg, C. B., Cramer, L. D., Hoskins, W. J. & Brennan, M. F. Impact of hospital volume on operative mortality for major cancer surgery. JAMA 280, 1747–1751 (1998).

    CAS  PubMed  Google Scholar 

  97. Birkmeyer, J. D. et al. Hospital volume and surgical mortality in the United States. N. Engl. J. Med. 346, 1128–1137 (2002).

    PubMed  Google Scholar 

  98. Gould, J. C. et al. Perioperative safety and volume: outcomes relationships in bariatric surgery: a study of 32,000 patients. J. Am. Coll. Surg. 213, 771–777 (2011).

    PubMed  Google Scholar 

  99. Mitchell, J. et al. Avoidable reoperations for thyroid and parathyroid surgery: effect of hospital volume. Surgery 144, 899–906; discussion 906–897 (2008).

    PubMed  Google Scholar 

  100. Sosa, J. A. et al. The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann. Surg. 228, 320–330 (1998).

    CAS  PubMed  PubMed Central  Google Scholar 

  101. Stavrakis, A. I., Ituarte, P. H., Ko, C. Y. & Yeh, M. W. Surgeon volume as a predictor of outcomes in inpatient and outpatient endocrine surgery. Surgery 142, 887–899; discussion 887–899 (2007).

    PubMed  Google Scholar 

  102. Boudourakis, L. D., Wang, T. S., Roman, S. A., Desai, R. & Sosa, J. A. Evolution of the surgeon-volume, patient-outcome relationship. Ann. Surg. 250, 159–165 (2009).

    PubMed  Google Scholar 

  103. Kandil, E., Noureldine, S. I., Abbas, A. & Tufano, R. P. The impact of surgical volume on patient outcomes following thyroid surgery. Surgery 154, 1346–1352; discussion 1352–1343 (2013).

    PubMed  Google Scholar 

  104. Tuggle, C. T., Park, L. S., Roman, S., Udelsman, R. & Sosa, J. A. Rehospitalization among elderly patients with thyroid cancer after thyroidectomy are prevalent and costly. Ann. Surg. Oncol. 17, 2816–2823 (2010).

    PubMed  Google Scholar 

  105. Sosa, J. A. et al. Clinical and economic outcomes of thyroid and parathyroid surgery in children. J. Clin. Endocrinol. Metab. 93, 3058–3065 (2008).

    CAS  PubMed  Google Scholar 

  106. Grogan, R. H. et al. A population-based prospective cohort study of complications after thyroidectomy in the elderly. J. Clin. Endocrinol. Metab. 97, 1645–1653 (2012).

    CAS  PubMed  Google Scholar 

  107. Hauch, A., Al-Qurayshi, Z., Randolph, G. & Kandil, E. Total thyroidectomy is associated with increased risk of complications for low- and high-volume surgeons. Ann. Surg. Oncol. 21, 3844–3852 (2014).

    PubMed  Google Scholar 

  108. Adam, M. A. et al. Is there a minimum number of thyroidectomies a surgeon should perform to optimize patient outcomes? Ann. Surg. 265, 402–407 (2017).

    PubMed  Google Scholar 

  109. Cox, C. et al. Lobectomy for treatment of differentiated thyroid cancer: can patients avoid postoperative thyroid hormone supplementation and be compliant with the American Thyroid Association guidelines? Surgery 163, 75–80 (2018).

    PubMed  Google Scholar 

  110. Kebebew, E., Duh, Q. Y. & Clark, O. H. Total thyroidectomy or thyroid lobectomy in patients with low-risk differentiated thyroid cancer: surgical decision analysis of a controversy using a mathematical model. World J. Surg. 24, 1295–1302 (2000).

    CAS  PubMed  Google Scholar 

  111. Liu, J. B. et al. Variation of thyroidectomy-specific outcomes among hospitals and their association with risk adjustment and hospital performance. JAMA Surg. 153, e174593 (2017).

    Google Scholar 

  112. Lim, H., Devesa, S. S., Sosa, J. A., Check, D. & Kitahara, C. M. Trends in thyroid cancer incidence and mortality in the United States, 1974–2013. JAMA 317, 1338–1348 (2017).

    Google Scholar 

  113. Lithwick-Yanai, G. et al. Multicentre validation of a microRNA-based assay for diagnosing indeterminate thyroid nodules utilising fine needle aspirate smears. J. Clin. Pathol. 70, 500–507 (2017).

    CAS  PubMed  PubMed Central  Google Scholar 

  114. Labourier, E. et al. Molecular testing for miRNA, mRNA, and DNA on fine-needle aspiration improves the preoperative diagnosis of thyroid nodules with indeterminate cytology. J. Clin. Endocrinol. Metab. 100, 2743–2750 (2015).

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

J.A.S. is a member of the Data Monitoring Committee of the Medullary Thyroid Cancer Consortium Registry supported by Novo Nordisk, GlaxoSmithKline, Astra-Zeneca and Eli Lilly.

Author information

Authors and Affiliations

  1. Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Tracy S. Wang

  2. Department of Surgery, University of California at San Francisco, San Francisco, CA, USA

    Julie Ann Sosa

Authors
  1. Tracy S. Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Julie Ann Sosa
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

T.S.W. researched the data for the article. T.S.W. and J.A.S. both provided substantial contribution to the discussion of the content, wrote the article and reviewed and/or edited the manuscript before submission.

Corresponding author

Correspondence to Tracy S. Wang.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Glossary

Active surveillance

A management approach that can be an alternative to immediate surgery in patients with low-risk thyroid cancer.

Positive predictive value

The proportion of positive results that are true positive results.

Negative predictive value

The proportion of negative results that are true negative results.

Sensitivity

The proportion of positive tests that are correctly identified as positive.

Specificity

The proportion of negative tests that are correctly identified as negative.

Hürthle cell neoplasm

A tumour of the thyroid gland composed of Hürthle cells.

Hilum

The depressed area of the surface of a lymph node through which lymphatics and blood vessels enter and exit the node.

Lymph node ratio

The number of metastatic lymph nodes divided by the total number of lymph nodes removed.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, T.S., Sosa, J.A. Thyroid surgery for differentiated thyroid cancer — recent advances and future directions. Nat Rev Endocrinol 14, 670–683 (2018). https://doi.org/10.1038/s41574-018-0080-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41574-018-0080-7

This article is cited by

Search

Advanced search

Quick links

Nature Briefing: Cancer

Sign up for the Nature Briefing: Cancer newsletter — what matters in cancer research, free to your inbox weekly.

Get what matters in cancer research, free to your inbox weekly. Sign up for Nature Briefing: Cancer