THYROID-CANCER MANAGEMENT

OBJECTIVE Thyroid cancer is the commonest endocrine malignancy, yet management remains controversial. Many endocrinologists advocate diagnosis by fine needle aspiration (FNA), treatment by thyroidectomy, ablative radioiodine (I-131) and TSH suppression, together with follow-up with I-131 scans or thyroglobulin (Tg) measurements. I-131 (therapy or diagnosis) 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 practice in a large Edinburgh teaching hospital to establish whether a need existed for local guidelines for the management of thyroid cancer. DESIGN AND PATIENTS Retrospective case-note audit of 46 patients, aged 55 (range 26-86) years, admitted between 1988 and 1993 with a diagnosis of thyroid cancer. RESULTS Diagnosis: Our FNA false negative rate was high (13%), aspiration technique varied considerably, and cytological reporting was not standardized. Treatment: Three (11%) patients received I-131 despite suboptimal TSH levels because of poorly developed mechanisms to prevent this, and 7 (25%) patients had inadequate suppression of TSH as a result of poor interspecialty communication. Follow-up: Three (11%) patients were scanned despite TSH levels <30 mIU/I, and in 5 (18%) Tg checks were incomplete. CONCLUSIONS This audit identifies several shortcomings from what might be considered optimum management of thyroid cancer; practice was far from uniform even among the endocrinologists within a single hospital and interdisciplinary communication was poor. A locally agreed and implemented protocol should address most of these problems and improve the care of thyroid cancer patients.