P28: Hurthle cell carcinoma - Is a hemithyroidectomy enough?

Friday, March 24, 2023

11:31 AM – 11:36 AM

Location: SSO HUB: Breast & Endocrine Zone

Poster Presenter(s)

Trenton Foster, MD

Assistant Professor of Surgery
Endocrine and Metabolic Surgery, Department of Surgery, Mayo Clinic
Rochester, Minnesota, United States

Disclosure information not submitted.

Author(s)

Benzon M. Dy, MD

Associate Professor
Mayo Clinic
Rochester, Minnesota, United States

Disclosure information not submitted.

Author(s)

Benzon M. Dy, MD

Associate Professor
Mayo Clinic
Rochester, Minnesota, United States

Disclosure information not submitted.
AH

Andres Henriquez, MD

Fellow
Department of Endocrinology, Mayo Clinic, United States

Disclosure information not submitted.
RV

Robert Vierkant, M.S.

Principal Biostatistician
Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic
Rochester, Minnesota, United States

Disclosure information not submitted.
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lyden melanie, MD

Professor of Surgery
Endocrine and Metabolic Surgery, Department of Surgery, Mayo Clinic
Rochester, Minnesota, United States

Disclosure information not submitted.
TM

Travis McKenzie, MD

Professor of Surgery
Endocrine and Metabolic Surgery, Department of Surgery, Mayo Clinic
Rochester, Minnesota, United States

Disclosure information not submitted.
MR

Mabel Ryder, MD

Assistant Professor of Medicine
Endocrinology, Diabetes, and Metabolism; Department of Endocrinology, Mayo Clinic
Rochester, Minnesota, United States

Disclosure information not submitted.

Introduction: Hurthle cell carcinoma has traditionally been managed with total thyroidectomy. However, current evidence suggests that there is limited benefit to this approach due to lack of radioactive iodine (RAI) uptake and therapeutic effects on managing recurrence and distant disease. We sought to compare outcomes of Hurthle cell carcinoma managed with hemi vs. total thyroidectomy.

Methods: A retrospective review of 309 patients undergoing surgery for Hurthle cell carcinoma at a single center was reviewed from 2000-2019. A subcohort of patients was selected that matched each hemithyroidectomy patient (HEMI) to a paired total thyroidectomy patient (TOTAL) on age and TNM staging. Associations of clinical and pathological features with surgery type were examined using paired t-tests and exact McNemar tests. Survival and recurrence were examined using Cox regression analysis, accounting for the matched design.

Results: We identified 42 HEMI patients; 69% female, median age of 57y (range 20-85), Tx/T1 = 16, T2/T3 = 26, nodal disease present in 1 and metastatic disease present in one patient. Compared to the 42 matched TOTAL patient cohort, we found no significant associations of surgery type with the matching variables of age and TNM staging. Surgery type was also not associated with gender, race, personal or family history of thyroid disease, presence of non-thyroid malignancy, pathology or focality (p >0.05 for all variables).

Over a mean follow-up of 5.7 years (range 0.1-20.5), there were no differences in rates of recurrence free survival (p=0.065), overall survival (p=0.806) or disease-specific survival across surgery type. We observed 10 disease recurrences in the matched cohort (8 TOTAL, 2 HEMI). TOTAL patients were more likely to receive RAI (64% vs. 26%, p=0.0001) Eleven patients died (5 TOTAL, 6 HEMI) and 3 died from their disease (3 TOTAL, 0 HEMI) with all 3 having received RAI.

Conclusions: Hemithyroidectomy may be a reasonable treatment option for select patients with Hurthle cell carcinoma. Extent of thyroidectomy and RAI does not have a significant effect on recurrence free survival or overall survival in our matched cohort.

Learning Objectives:

Discuss the surgical management options for Hurthle cell carcinoma
Describe the benefits of radioactive iodine on management of Hurthle cell carcinoma
Demonstrate an understanding of factors affecting survival in Hurthle cell carcinoma