Controversies in Differentiated Thyroid Cancer with Dr. Julie Ann Sosa

We were so lucky to catch up with Dr. Julie Ann Sosa, who is the new Chair of Surgery at UCSF starting April 1st, 2018, and also world renowned endocrine surgeon on the newly updated staging guidelines for differentiated thyroid cancer and some common controversies in management in the US. We also chat about mentorship and her advice to learners at all stages! Check it out!

Background Reading:

2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer

Bryan R. Haugen, Erik K. Alexander, Keith C. Bible, Gerard M. Doherty, Susan J. Mandel, Yuri E. Nikiforov, Furio Pacini, Gregory W. Randolph, Anna M. Sawka, Martin Schlumberger, Kathryn G. Schuff, Steven I. Sherman, Julie Ann Sosa, David L. Steward,
R. Michael Tuttle, and Leonard Wartofsky

American Thyroid Association guidelines for both differentiated thyroid cancer and thyroid nodules. Differentiated thyroid cancer= papillary thyroid cancer, follicular thyroid cancer or Hurthle cell cancer.

Differentiated and Anaplastic Thyroid Carcinoma: Major Changes in the American Joint Committee on Cancer Eighth Edition Cancer Staging Manual

Nancy D. Perrier, James D. Brierley, and R. Michael Tuttle

Overview of the changes made from the 7th to 8th editions of the AJCC staging system for thyroid cancer. One major change is that cut point age for staging is now 55 years of age, rather than 45. 

NCCN Guidelines for Thyroid Carcinoma

Updated guidelines from the NCCN outlining the management strategy for patients diagnosed with thyroid cancer.

Papers we discussed:

Controversies in the Management of Low-Risk Differentiated Thyroid Cancer

Megan R. Haymart, Nazanene H. Esfandiari, Michael T. Stang, and Julia Ann Sosa

Great overview and discussion of the controversies in the management of low-risk differentiated thyroid cancer. Controversies discussed include: surgical management, radioactive iodine ablation therapy, thyroid hormone supplementation, and long-term surveillance.

An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid.

Ito Y, Uruno T, Nakano K, Takamura Y, Miya A, Kobayashi K, Yokozawa T, Matsuzuka F, Kuma S, Kuma K, Miyauchi A.

2003 article in Thyroid that demonstrated in a Japanese population with 10mm or less papillary thyroid micro carcinoma, active surveillance appears to be safe. In this observation trial patients with papillary micro carcinoma either elected to undergo thyroidectomy or active surveillance. Over 5 years of surveillance 27.5% of patients had an increased size of the lesion. 1.2% of patients developed lymph node disease. In total 35% of patients in the observation group went on to have surgery either due to progression or preference. No patients in the observation group had a thyroid cancer related death.

Extent of surgery affects survival for papillary thyroid cancer.

Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS, Sturgeon C.

Annals of Surgery article from 2007, that utilized NCDB data to demonstrate that total thyroidectomy leads to improved survival over thyroid lobectomy for patients 1cm+ papillary thyroid carcinoma.

Extent of surgery for papillary thyroid cancer is not associated with survival: an analysis of 61,775 patients.

Adam MA, Pura J, Gu L, Dinan MA, Tyler DS, Reed SD, Scheri R, Roman SA, Sosa JA.

Annals of Surgery article from 2014, that used NCDB data from 1998-2006 to look at outcomes after lobectomy or total thyroidectomy for papillary thyroid cancer 1cm+. The authors found equivalent survival for total thyroidectomy and thyroid lobectomy groups, unlike the Bilimoria study from 2007. Of note, the NCDB began more accurately tracking comorbidities in 2003, and it is likely that the addition of this data allowed for more accurate modeling–and thus the change in study outcome.