• Mohamed Abdelgadir Adam, John Pura, Paolo Goffredo, Michaela A Dinan, Terry Hyslop, Shelby D Reed, Randall P Scheri, Sanziana A Roman, and Julie A Sosa.
• Department of Surgery (M.A.A., R.P.S., S.A.R., J.A.S.), Duke University Medical Center; Department of Biostatistics (J.P., T.H.), Duke University; and Duke Clinical Research Institute (P.G., M.A.D., S.D.R., J.A.S.), Durham, North Carolina 27710.
• J. Clin. Endocrinol. Metab. 2015 Jan 1; 100 (1): 115-21.

ContextPapillary thyroid cancer (PTC) patients <45 years old are considered to have an excellent prognosis; however, current guidelines recommend total thyroidectomy for PTC tumors >1.0 cm, regardless of age.ObjectiveOur objective was to examine the impact of extent of surgery on overall survival (OS) in patients <45 years old with stage I PTC of 1.1 to 4.0 cm.Design, Setting, And PatientsAdult patients <45 years of age undergoing surgery for stage I PTC were identified from the National Cancer Data Base (NCDB, 1998-2006) and the Surveillance, Epidemiology, and End RESULTS dataset (SEER, 1988-2006).Main Outcome MeasureMultivariable modeling was used to compare OS for patients undergoing total thyroidectomy vs lobectomy.ResultsIn total, 29 522 patients in NCDB (3151 lobectomy, 26 371 total thyroidectomy) and 13 510 in SEER (1379 lobectomy, 12 131 total thyroidectomy) were included. Compared with patients undergoing lobectomy, patients having total thyroidectomy more often had extrathyroidal and lymph node disease. At 14 years, unadjusted OS was equivalent between total thyroidectomy and lobectomy in both databases. After adjustment, OS was similar for total thyroidectomy compared with lobectomy across all patients with tumors of 1.1 to 4.0 cm (NCDB: hazard ratio = 1.45 [confidence interval = 0.88-2.51], P = 0.19; SEER: 0.95 (0.70-1.29), P = 0.75) and when stratified by tumor size: 1.1 to 2.0 cm (NCDB: 1.12 [0.50-2.51], P = 0.78; SEER: 0.95 [0.56-1.62], P = 0.86) and 2.1 to 4.0 cm (NCDB: 1.93 [0.88-4.23], P = 0.10; SEER: 0.94 [0.60-1.49], P = 0.80).ConclusionsAfter adjusting for patient and clinical characteristics, total thyroidectomy compared with thyroid lobectomy was not associated with improved survival for patients <45 years of age with stage I PTC of 1.1 to 4.0 cm. Additional clinical and pathologic factors should be considered when choosing extent of resection.

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