S. Xie1, C.B. Jensen1,2,3, A. Sinha1, E.M. Bacon1, L.N. Krumeich1, H.J. Underwood1, D.T. Hughes1, P.G. Gauger1, H. Nathan1, M.A. Rubyan1, S.C. Pitt1 1University Of Michigan, Ann Arbor, MI, USA 2University Of Wisconsin, Madison, WI, USA 3University Of Michigan, National Clinician Scholars Program, Ann Arbor, MI, USA
Introduction: The 2015 American Thyroid Association (ATA) Guidelines marked a paradigm shift in the treatment of lower-risk thyroid cancer, recommending thyroid lobectomy as an alternative to total thyroidectomy to mitigate concerns about overtreatment. While lobectomy rates initially increased, little is known about the long-term effects of the guidelines. This study aimed to examine trends in thyroid lobectomy and the subsequent rates of completion thyroidectomy following the guideline update.
Methods: This retrospective cohort study evaluated adults ≥18 years-old with a diagnosis of thyroid cancer (ICD-10 code C73) who underwent thyroidectomy in a statewide claims registry from 2015-2022. CPT codes were used to categorize patients as having a thyroid lobectomy (60220), total or subtotal thyroidectomy (60240, 60225, 60252), and/or completion thyroidectomy (60260). To identify a lower-risk cancer cohort, patients treated with radioactive iodine (79005) within 180 days of surgery were excluded. Poisson regression was used to determine the significance of thyroidectomy trends over time.
Results: During the study period, 2,615 patients underwent surgery for thyroid cancer at 80 facilities by 297 surgeons. The mean age of the cohort was 56.8±15.2 years; patients were predominantly female (75.3%), White (83.3%), and commercially insured (60.0%). Demographic characteristics were similar across the three procedure groups. Of all patients, 874 (33.4%) underwent thyroid lobectomy, 1,537 (58.8%) underwent a total or subtotal thyroidectomy, and 204 (7.8%) underwent a completion thyroidectomy. From 2015 to 2022, annual thyroid lobectomy rates increased significantly from 22.5% to 40.9% (p<0.001), while annual total/subtotal thyroidectomy rates decreased from 68.4% to 50.9% (p=0.047). Completion thyroidectomy rates remained stable (p=0.745; Figure 1).
Conclusion: Since the introduction of the 2015 ATA Guidelines, less extensive surgery (thyroid lobectomy) has been increasingly utilized in the initial management of lower-risk thyroid cancer. Despite more limited index surgery, rates of completion thyroidectomy remained stable over time. Knowledge of these trends may reduce barriers to selection of up front thyroid lobectomy.