THYROID-CANCER MANAGEMENT

OBJECTIVE Thyroid cancer is the commonest endocrine malignancy, yet ma nagement remains controversial. Many endocrinologists advocate diagnos is by fine needle aspiration (FNA), treatment by thyroidectomy, ablati ve radioiodine (I-131) and TSH suppression, together with follow-up wi th I-131 scans or thyroglobulin (Tg) measurements. I-131 (therapy or d iagnosis) is given only when TSH is > 30 mIU/I. With this strategy in mind, the aim of the present study was to audit existing clinical prac tice in a large Edinburgh teaching hospital to establish whether a nee d existed for local guidelines for the management of thyroid cancer. D ESIGN AND PATIENTS Retrospective case-note audit of 46 patients, aged 55 (range 26-86) years, admitted between 1988 and 1993 with a diagnosi s of thyroid cancer. RESULTS Diagnosis: Our FNA false negative rate wa s high (13%), aspiration technique varied considerably, and cytologica l reporting was not standardized. Treatment: Three (11%) patients rece ived I-131 despite suboptimal TSH levels because of poorly developed m echanisms to prevent this, and 7 (25%) patients had inadequate suppres sion of TSH as a result of poor interspecialty communication. Follow-u p: Three (11%) patients were scanned despite TSH levels <30 mIU/I, and in 5 (18%) Tg checks were incomplete. CONCLUSIONS This audit identifi es several shortcomings from what might be considered optimum manageme nt of thyroid cancer; practice was far from uniform even among the end ocrinologists within a single hospital and interdisciplinary communica tion was poor. A locally agreed and implemented protocol should addres s most of these problems and improve the care of thyroid cancer patien ts.