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Invited Commentary
May 17, 2010

Should Papillary Thyroid Carcinoma Be Observed?: A Word of CautionComment on “Thyroid Cancer Survival in the United States”

Arch Otolaryngol Head Neck Surg. 2010;136(5):444-446. doi:10.1001/archoto.2010.56

We read with interest the analysis by Davies and Welch of over 35 000 patients with localized papillary thyroid carcinoma (PTC) within the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) 17 registry comparing the outcomes of a selected subgroup who were not treated (n = 440) with those undergoing definitive surgical treatment. While there was a significant survival advantage (both disease specific and overall) for those undergoing definitive treatment (log rank P < .001), the authors conclude that because the absolute difference was so small (2% at 20 years), (1) localized PTC can be safely observed without surgery and (2) the extent of surgery does not influence subsequent survival. In our practice, we certainly recommend observation for many patients with PTC, in particular those with severe medical comorbidities, more pressing malignant neoplasms, or small-volume recurrent PTCs; but we unfortunately also have to treat many patients with recurrent PTC (or dedifferentiated PTC), often resulting in significant morbidities and quality-of-life changes. Just as the authors point out the risks of permanent hypoparathyroidism and laryngeal dysfunction, we lament the suffering caused by recurrent PTC after an inadequate initial evaluation and/or treatment. What we truly need is not only appropriate observation for highly selected cases but also appropriate biopsy, evaluation, and treatment by an experienced multidisciplinary team.

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