Surgeons’ Attitudes on Total Thyroidectomy vs Lobectomy for Management of Papillary Thyroid Microcarcinoma

The incidence of papillary thyroid cancer has increased in the past 25 years without a clear increase in thyroid cancer deaths. 1 Given these findings, there has been a shift toward recommending conservative surgical options, with current management guidelines favoring lobectomy, especially for patients with papillary thyroid microcarcinoma.2 Despite these recommendations, some studies have reported an increasing number of total thyroidectomies performed for small tumors, even with equivocal oncologic outcomes.3 The aim of this study is to identify surgeons' attitudes regarding surgical management of microcarcinomas with the hypothesis that surgeons consider other factors, in addition to tumor size, when selecting a surgical procedure.Methods | This survey study was approved by the institutional review boards of the University of Michigan, the University of Southern California, Los Angeles, and Emory University as well as the Committee for the Protection of Human Subjects, the Georgia Department of Public Health, and the California Cancer Registry.A waiver of written informed consent was obtained from all participants because a returned completed survey serves as implied consent to participate.Treating surgeons for patients with differentiated thyroid cancer were identified from the Surveillance, Epidemiology, and End Results (SEER) registries of Georgia and Los Angeles Counties.Between October 2018 and August 2019, surveys were mailed to 264 thyroid cancer surgeons.More detail on the survey methods, including the use of the modified Dillman method, has been published elsewhere.4 As a part of the survey, surgeons were presented with the following vignette: "A 40-year-old female patient presents to your office after an FNA [fine-needle aspiration] of a 0.9-cm right thyroid nodule was consistent with papillary thyroid cancer.No suspicious lymph nodes were seen on ultrasound evaluation."Surgeons were asked which of 4