DR.Guttler’s Patient Thyroid Blog Post: More extensive total thyroidectomy than is needed in 50% of Cases with class V cytology.
- 25%-50% of Bethesda V thyroid nodules may be benign, noninvasive follicular neoplasm with papillary-like nuclear features, or low risk cancer.
- Total thyroidectomy for Bethesda V nodules may therefore be overtreatment.
- cytology and ultrasound may guide extent of surgery for these nodules.
- a 10-y prospective database starting January 1, 2004, cytomorphologic and ultrasonographic features of thyroid nodules with Bethesda V cytology were reviewed.
- Overtreatment was defined as total thyroidectomy when histopathology revealed benign nodule, noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) or a unilateral < 4 cm low risk cancer.
- Sixty-three patients were included in the study. Seventeen (27%) had benign, 14 (22%) NIFTP, and 32 (51%) malignant nodules.
- 56 patients who underwent total thyroidectomy, 14 and 11 had a benign or NIFTP nodule, respectively, and 13 had a unilateral < 4 cm low risk cancer,
- 68% (38/56) were overtreated with total thyroidectomy.
- Warning to thyroid patients with Class V cytology.
- Do not submit to a total thyroidectomy without getting molecular marker testing.
- This can be done on the slides from your biopsy or obtained with a new biopsy.
- A negative classifier or lack of cancer specific markers like BRAF can help you obtain a lobectomy and keep half of your thyroid gland.
- You will be able to avoid the trauma of a total and may not need thyroid hormone or additional therapy.
- Call me for my opinion.
- 310-393-8860 or email to firstname.lastname@example.org
- Ask for Alicia.