The Role of Isthmusectomy in Well-Differentiated Thyroid Carcinoma

  • Background / Purpose
    The role of isthmusectomy in the treatment of well-differentiated thyroid carcinoma (WDTC) is controversial. There are no specific guidelines for management of isthmus lesions with WDTC.  In this study, we analyze the outcomes of WDTC managed by isthmusectomy alone.

    After IRB approval, patients treated with thyroid Isthmusectomy alone were identified from an institutional database of 6,262 patients with WDTC. Patients with surgery other than an isthmusectomy  were excluded. Forty-three patients were identified; patient and tumor characteristics were analyzed. disease-specific survival (DSS) and recurrence free survival (RFS) were calculated using the Kaplan-Meier method.

    According to the 8th edition of the American Joint Committee on Cancer staging system, 42 patients were Stage I and one patient was Stage II. The pathological T stage was T1 for 41 patients and T2 for 2 patients. All were clinical N0, but 10 patients (23.3%) had incidental perithyroidal lymph node metastasis (pN1a) on histopathology review. Using the American Thyroid Association risk stratification system, 23 patients were estimated as low risk and 19 patients as intermediate risk.  One patient had a local (right lobe) recurrence at 123 months, and two patients had regional recurrences at 37 and 41 months.  The 5-and 10-year DSS was 100%. The 5- and 10-year RFS was 93.1%.

    Isthmusectomy alone may be an appropriate treatment option in select patients with low/intermediate risk WDTC limited to the isthmus.


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