Other Articles |

Surgical Practice Patterns in the Treatment of Papillary Thyroid Microcarcinoma

Arthur W. Wu, MD; Marilene B. Wang, MD; Chau T. Nguyen, MD
Arch Otolaryngol Head Neck Surg. 2010;136(12):1182-1190. doi:10.1001/archoto.2010.193.
Text Size: A A A
Published online

Background  Recently, there has been a debate regarding total thyroidectomy vs hemithyroidectomy for papillary thyroid microcarcinoma (PTMC).

Objective  To determine whether there were significant differences in the treatment of PTMC depending on a physician's experience, age, training, and location.

Methods  A 10-question survey was distributed to otolaryngologists, general surgeons, and endocrine surgeons. It included 4 clinical scenarios, 2 questions querying clinical reasoning, and 4 demographic questions (training, surgical volume, location, and age). The demographic variables were used to analyze responses to the 4 clinical scenarios with bivariate and multivariate statistics.

Results  A total of 438 responders completed the survey. Given a single subcentimeter PTMC, 70.3% of surgeons recommended no further surgery after a hemithyroidectomy, yet 29.7% believed that completion thyroidectomy was necessary. Otolaryngologists chose total thyroidectomy more frequently, as did surgeons from the South and West. Given PTMC with lymphatic invasion, 392 (89.5%) responders recommended completion thyroidectomy, with otolaryngologists again more inclined toward completion surgery. Given multifocal PTMC, 85.4% chose completion thyroidectomy, with surgeons in the South and West recommending total thyroidectomy more frequently compared with those in the Northeast. Improved survival, surgeon preference, and need for thyroid suppression were rated relatively insignificant. Ease of patient follow-up and multifocality of disease were judged very significant. Influence from national guidelines and current literature was rated as only somewhat or minimally significant.

Conclusions  In this survey, most surgeons seemed to follow national guidelines regarding the surgical treatment of PTMC. However, significant differences in the treatment and perception of PTMC exist based on surgical training and location.

Figures in this Article


Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours


Place holder to copy figure label and caption
Figure 1.

Questionnaire for surgical practice patterns in the treatment of papillary thyroid microcarcinoma (PTMC).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Results from clinical scenarios 1 to 4. PTMC indicates papillary thyroid microcarcinoma.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

Clinical reasoning and decision making in the treatment of papillary thyroid microcarcinoma: 0 (not applicable), 1 (little significance), 2 (somewhat significant), 3 (very significant), or 4 (most significant).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.

Ranking determining factors in the treatment of papillary thyroid microcarcinoma (PTMC) among responding surgeons.

Graphic Jump Location




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment


Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 2

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.