Article
Five-year follow-up results after treatment of low-, intermediate- and high-risk thyroid cancer by combined thyroidectomy and radio ablation therapy in euthyroidism
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Authors
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Nikos Emmanouilidis
- Medizinische Hochschule Hannover, klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Hannover
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Wolfram H. Knapp
- Medizinische Hochschule Hannover, klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Hannover
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Jürgen Klempnauer
- Medizinische Hochschule Hannover, klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Hannover
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Georg Friedrich Wilhelm Scheumann
- Medizinische Hochschule Hannover, klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Hannover
| Published: | April 26, 2013 |
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Outline
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Background: Differentiated thyroid cancer treatment usually consists of thyroidectomy as a first step and radio ablation therapy (RAT) by 131iodine as a second step. RAT is usually performed 4 to 6 weeks after surgery and levo-thyroxine (L-T4) withdrawal in a state of distinct hypothyroidism. The first objective of this study was to demonstrate that an effective radio ablative therapy (RAT) for low-, intermediate- and high-risk differentiated thyroid cancers can be conducted in euthyroidism within a combined setting of thyroidectomy and radio ablation therapy (MHH protocol) and without an increase of tumor recurrences – even in high-risk tumors. The second objective was to demonstrate the socio-economic advantages of the MHH protocol in regard to quality of life and job performance.
Material and methods: Patients were randomized either for thyroidectomy and RAT within a few days and after rhTSH preconditioning (MHH protocol) or thyroidectomy and RAT separated by 4 weeks of L-T4 withdrawal (standard protocol). Tumor staging and risk category grading into low-, intermediate- or high-risk tumours. Follow-up controls were conducted at 3 months, 6 months, 12 months and thereafter on an annual basis up to 8 years after surgery. Parameters of quality of life and job performance were filed using a questionnaire and were compared for both treatment strategies. Each patient completed a questionnaire regarding quality of life, job performance and sick leave time.
Results and Conclusions: Patients treated by the MHH protocol did not have a significantly higher rate of tumor recurrence – even for high-risk tumors. At the same time, the MHH protocol proved to be advantageous in regard to quality of life, sick leave time and job performance when compared with the standard procedure of RAT in hypothyroidism. Figure 1 [Fig. 1].
Conclusion: We conclude that RAT after rhTSH preconditioning and in quick succession after thyroidectomy should be the standard procedure in the initial treatment of DTC - regardless of the tumor risk category.
