Research Article| Volume 165, ISSUE 3, P629-636, March 2019

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Total thyroidectomy's association with survival in papillary thyroid cancers and the high proportion of total thyroidectomy in low-risk patients: Analysis of Korean nationwide data

Published:October 17, 2018DOI:


      Papillary thyroid cancer has an excellent prognosis, but the appropriate level of treatment is controversial. We compared survival between total thyroidectomy and less-than-total thyroidectomy, and examined the proportion of patients with papillary thyroid cancer in Korea undergoing total thyroidectomy.


      A nationwide sample of 5,230 papillary thyroid cancer patients was included (total thyroidectomy: 4,262, less-than-total thyroidectomy: 968). Using multivariate Cox regression, we compared overall survival and cause-specific survival by the extent of thyroidectomy (total thyroidectomy versus less-than-total thyroidectomy) for a 1:1 optimal match via the propensity score and for the total study population. We also compared overall survival by extent of thyroidectomy and the proportion of total thyroidectomy in different risk groups using papillary thyroid cancer staging systems.


      We saw no difference in overall survival by extent of thyroidectomy in the propensity score matched population and the total study population (hazard ratio for less-than-total thyroidectomy 0.82, 95% confidence interval 0.52–1.29; hazard ratio for less-than-total thyroidectomy 1.03, 95% confidence interval 0.71–1.48, respectively). Similarly, there were no differences in thyroid cancer–specific survival by extent of thyroidectomy. None of the different risk groups showed differences in overall survival by surgical extent, although total thyroidectomy improved overall survival in older females with larger tumors. The proportion of papillary thyroid cancer patients who received a total thyroidectomy was 80% or greater regardless of risk group classification.


      Total thyroidectomy had no survival advantage over less-than-total thyroidectomy in Korean papillary thyroid cancer patients except in a specific high-risk group. 80% or more of low-risk papillary thyroid cancer patients received a total thyroidectomy. These results suggest that further patient-centered treatment which considers both quality of life and clinical outcome is needed.
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        • Brito JP
        • Hay ID
        • Morris JC
        Low risk papillary thyroid cancer.
        BMJ. 2014; 348: g3045
        • Kitahara CM
        • Sosa JA
        The changing incidence of thyroid cancer.
        Nat Rev Endocrinol. 2016; 12: 646-653
        • Brito JP
        • Morris JC
        • Montori VM
        Thyroid cancer: Zealous imaging has increased detection and treatment of low risk tumours.
        BMJ. 2013; 347: f4706
        • Oh CM
        • Jung KW
        • Won YJ
        • Shin A
        • Kong HJ
        • Lee JS
        Age-period-cohort analysis of thyroid cancer incidence in Korea.
        Cancer Res Treat. 2015; 47: 362-369
        • Park S
        • Oh CM
        • Cho H
        • Lee JY
        • Jung KW
        • Jun JK
        • et al.
        Association between screening and the thyroid cancer "epidemic" in South Korea: Evidence from a nationwide study.
        BMJ. 2016; 355: i5745
        • Ahn HS
        • Kim HJ
        • Welch HG
        Korea's thyroid-cancer "epidemic"—Screening and overdiagnosis.
        N Engl J Med. 2014; 371: 1765-1767
        • Cooper DS
        • Doherty GM
        • Haugen BR
        • Kloos RT
        • Lee SL
        • Mandel SJ
        • et al.
        Management guidelines for patients with thyroid nodules and differentiated thyroid cancer.
        Thyroid. 2006; 16: 109-142
        • Cooper DS
        • Doherty GM
        • Haugen BR
        • Kloos RT
        • Lee SL
        • et al.
        • American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer
        Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer.
        Thyroid. 2009; 19: 1167-1214
        • Haugen BR
        • Alexander EK
        • Bible KC
        • Doherty GM
        • Mandel SJ
        • Nikiforov YE
        • et al.
        2015 American Thyroid Association Management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American Thyroid Association Guidelines Task Force on thyroid nodules and differentiated thyroid cancer.
        Thyroid. 2016; 26: 1-133
        • Bilimoria KY
        • Bentrem DJ
        • Ko CY
        • Stewart AK
        • Winchester DP
        • Talamonti MS
        • et al.
        Extent of surgery affects survival for papillary thyroid cancer.
        Ann Surg. 2007; 246 (discussion 381–4): 375-381
        • Mendelsohn AH
        • Elashoff DA
        • Abemayor E
        • St John MA
        Surgery for papillary thyroid carcinoma: Is lobectomy enough?.
        Arch Otolaryngol Head Neck Surg. 2010; 136: 1055-1061
        • Adam MA
        • Pura J
        • Gu L
        • Dinan MA
        • Tyler DS
        • Reed SD
        • et al.
        Extent of surgery for papillary thyroid cancer is not associated with survival: An analysis of 61,775 patients.
        Ann Surg. 2014; 260 (discussion 605–7): 601-605
        • Lee J
        • Park JH
        • Lee CR
        • Chung WY
        • Park CS
        Long-term outcomes of total thyroidectomy versus thyroid lobectomy for papillary thyroid microcarcinoma: Comparative analysis after propensity score matching.
        Thyroid. 2013; 23: 1408-1415
        • Kwon H
        • Jeon MJ
        • Kim WG
        • Park S
        • Kim M
        • Song DE
        • et al.
        A comparison of lobectomy and total thyroidectomy in patients with papillary thyroid microcarcinoma: A retrospective individual risk factor–matched cohort study.
        Eur J Endocrinol. 2017; 176: 371-378
        • Lang BH
        • Lo CY
        • Chan WF
        • Lam KY
        • Wan KY
        Staging systems for papillary thyroid carcinoma: A review and comparison.
        Ann Surg. 2007; 245: 366-378
        • D'Agostino Jr., RB
        Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group.
        Stat Med. 1998; 17: 2265-2281
        • Stuart EA.
        Matching methods for causal inference: A review and a look forward.
        Stat Sci. 2010; 25: 1-21
      1. King G, Nielsen R, Coberley C, Pope JE, Wells A. Comparative Effectiveness of Matching Methods for Causal Inference. 2011. [Cited May 23, 2018]. Available from:

        • Passler C
        • Prager G
        • Scheuba C
        • Kaserer K
        • Zettinig G
        • Niederle B
        Application of staging systems for differentiated thyroid carcinoma in an endemic goiter region with iodine substitution.
        Ann Surg. 2003; 237: 227-234
        • Haigh PI
        • Urbach DR
        • Rotstein LE
        Extent of thyroidectomy is not a major determinant of survival in low- or high-risk papillary thyroid cancer.
        Ann Surg Oncol. 2005; 12: 81-89
        • Nixon IJ
        • Ganly I
        • Patel SG
        • Palmer FL
        • Whitcher MM
        • Tuttle RM
        • et al.
        Thyroid lobectomy for treatment of well differentiated intrathyroid malignancy.
        Surgery. 2012; 151: 571-579
        • Ebina A
        • Sugitani I
        • Fujimoto Y
        • Yamada K
        Risk-adapted management of papillary thyroid carcinoma according to our own risk group classification system: Is thyroid lobectomy the treatment of choice for low-risk patients?.
        Surgery. 2014; 156 (discussion 1588–9): 1579-1588
        • Ito Y
        • Miyauchi A
        • Kihara M
        • Higashiyama T
        • Kobayashi K
        • Miya A
        Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation.
        Thyroid. 2014; 24: 27-34
        • Sugitani I
        • Toda K
        • Yamada K
        • Yamamoto N
        • Ikenaga M
        • Fujimoto Y
        Three distinctly different kinds of papillary thyroid microcarcinoma should be recognized: Our treatment strategies and outcomes.
        World J Surg. 2010; 34: 1222-1231
        • Momesso DP
        • Tuttle RM
        Update on differentiated thyroid cancer staging.
        Endocrinol Metab Clin North Am. 2014; 43: 401-421
        • Lee YS
        • Nam KH
        • Chung WY
        • Chang HS
        • Shigematsu N
        • Takami H
        • et al.
        Practical management of well differentiated thyroid carcinoma in Korea.
        Endocr J. 2008; 55: 1015-1024
        • Hauch A
        • Al-Qurayshi Z
        • Randolph G
        • Kandil E
        Total thyroidectomy is associated with increased risk of complications for low- and high-volume surgeons.
        Ann Surg Oncol. 2014; 21: 3844-3852
        • Ryu J
        • Ryu YM
        • Jung YS
        • Kim SJ
        • Lee YJ
        • Lee EK
        • et al.
        Extent of thyroidectomy affects vocal and throat functions: A prospective observational study of lobectomy versus total thyroidectomy.
        Surgery. 2013; 154: 611-620
        • Shaha AR
        Implications of prognostic factors and risk groups in the management of differentiated thyroid cancer.
        Laryngoscope. 2004; 114: 393-402
        • Ito Y
        • Miyauchi A
        Prognostic factors and therapeutic strategies for differentiated carcinomas of the thyroid.
        Endocr J. 2009; 56: 177-192
        • Haugen BR.
        2015 American Thyroid Association Management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: What is new and what has changed?.
        Cancer. 2017; 123: 372-381
        • Yi KH.
        The revised 2016 Korean Thyroid Association guidelines for thyroid nodules and cancers: Differences from the 2015 American Thyroid Association guidelines.
        Endocrinol Metab (Seoul). 2016; 31: 373-378
        • Ahn HS
        • Welch HG
        South Korea's thyroid-cancer "epidemic"—Turning the tide.
        N Engl J Med. 2015; 373: 2389-2390
        • Lee YS
        • Chang HS
        • Park CS
        Changing trends in the management of well-differentiated thyroid carcinoma in Korea.
        Endocr J. 2016; 63: 515-521
        • Lee S
        • Lee YY
        • Yoon HJ
        • Choi E
        • Suh M
        • Park B
        • et al.
        Responses to overdiagnosis in thyroid cancer screening among Korean women.
        Cancer Res Treat. 2016; 48: 883-891