CURRENT TRENDS IN THE MANAGEMENT OF WELL-DIFFERENTIATED PAPILLARY THYROID-CARCINOMA

Clinical members of the American Thyroid Association were surveyed in regard to their diagnostic assessment, treatment, and long term assess ment of differentiated papillary thyroid carcinoma. For a 39-yr-old fe male with a 2-cm solitary nodule and no history of radiation (index pa tient), respondents were asked to provide their preferences for diagno stic evaluation, treatment assuming a papillary carcinoma was focal, a nd follow-up. Of 408 surveys mailed, 233 (57.1%) were analyzed. Diagno stic studies included thyroid scan (56%), fine needle aspiration (96%) , total serum T-4 (49%), and third generation TSH (56%). Treatment inc luded surgery (99%), with 86% preferring near-total/total thyroidectom y. After surgery, 61% recommended I-131 ablation; long term therapy us ing L-T-4 alone was recommended by 97%, with most preferring suppressi on to a target TSH level of less than 0.01 mu IU/mL (22%), 0.01-0.05 ( 38%), or 0.06-0.50 (32%). For variations from the index patient, respo ndents' treatment were not different for a history of radiation, age o f either 16 or 60 yr, nodule size of 1.5 cm, male sex, the presence of less than 1-cm multiple foci in the contralateral lobe, or capsular i nvasion of the nodule. Treatment and follow-up did change if there was blood vessel invasion or distant metastasis. In summary, our survey i ndicated consensus on diagnostic assessment of the index patient by fi ne needle aspiration and management by surgery and I-131 therapy. Howe ver, management varied widely for the ablative dose of I-131, the targ et TSH level after ablation, and the frequency and type of follow up.