AN AUDIT OF MANAGEMENT OF DIFFERENTIATED THYROID CANCERS

Abstract

Objective: Management of differentiated thyroid cancers (DTC) remains controversial with a wide variation in clinical practice. The aim of this audit was to find out strength and weakness of treatment strategy being used at a tertiary care hospital. Patients and Method: Patients with DTC enrolled from January 2006 till May 2009 were reviewed. Histopathology, extent of surgery, measurement of serum markers, radioiodine-131 (I-131) ablation, use of various imaging techniques and follow up rate at 1 year was evaluated. Results: One hundred and six patients (M:F 36:72 with mean age of 40.55 ±16 years) were enrolled and papillary (72%) followed by follicular carcinomas (15%) were the most common tumors. Total or completion thyroidectomies were performed in 78 and 22 patients respectively while 6 had partial thyroidectomies. Serum TSH and thyroglobulin level with antibodies were measured in all patients at baseline and 1 year follow up. I-131 ablation was given (50-200 mCi) to every patient at a mean TSH level of 55.11 ± 31mU/L. Diagnostic whole body iodine scan (DWBIS) was performed in 36/106 (34%) patients at baseline and 30/48 (63%) at follow up. Therapeutic WBIS (TWBIS) was performed in 103/106 (97%) patients at baseline and 23/25 (92%) at follow up. Neck ultrasound was performed in 25% and 27% patients at baseline and follow up respectively. Follow up failure of 55% was seen at 1 year. Conclusions: This audit regarding the management of DTC at KIRAN reveals adequacy of extent of surgery, use of I-131 ablation, TWBIS and measurement of clinical markers are in good agreement with recommended guidelines. However, this audit shows over utilization of DWBIS, under-utilization of neck ultrasound and dismal follow-up at 1 year which need to be addressed properly.