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Assessment of the impact of 2015 American Thyroid Association guidelines in management of differentiated thyroid cancer patients

  • Sayak Choudhury
  • Archi Agrawal
  • Gouri Pantvaidya
  • Sneha Shah
  • Nilendu Purandare
  • Ameya Puranik
  • Venkatesh RangarajanEmail author
Original Article
  • 49 Downloads
Part of the following topical collections:
  1. Oncology – Head and Neck

Abstract

The 2015 American Thyroid Association (ATA) guideline have suggested modifications in the risk stratification (RS) for differentiated thyroid cancer (DTC) patients, introduced the concept of dynamic risk stratification (DRS) and redefined the role of radioactive iodine (RAI) in treatment algorithm. The aim of this retrospective audit was to assess the practical implications of these modifications in management of DTC.

Methods

A total of 138 DTC patients were stratified according to ATA 2009 and 2015 guidelines into low (LR), intermediate (IR) and high (HR) risk groups. Change in RS and in intention of RAI use was calculated. Deviation in administered RAI dosage from the guidelines was assessed. 1-year follow-up data was audited to assess how the DRS modified the initial risk estimate.

Results

A total of 11.6% of patients changed their RS categories in 2015 guidelines. A total of 10.1% got upstaged to HR, and 1.4% got downstaged to LR. In 2.17% of patients’ intention of RAI use changed to remnant ablation from adjuvant therapy and 65% of the LR patients won’t require any RAI therapy. A total of 26.7% of patients had received significantly more RAI dosage according to ATA 2015. At 1-year follow-up according to DRS 84% of LR, 75% of IR and 44% of HR patients showed excellent response (ER).

Conclusion

More patients changed RS to HR than to LR. Intention of RAI use changed in only a small number of patients. Significantly higher dosage of RAI is being administered to patients in current practice. The effect of DRS in modifying the initial RS was most prominent in IR, with most showing ER to initial therapy.

Keywords

Differentiated thyroid cancer American Thyroid Association Risk stratification Radioactive iodine Dynamic risk stratification 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Statement of informed consent

This study is a retrospective study therefore there is no direct contact with the patients. Waiver of consent was obtained from institutional ethics committee.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Sayak Choudhury
    • 1
  • Archi Agrawal
    • 1
  • Gouri Pantvaidya
    • 2
  • Sneha Shah
    • 1
  • Nilendu Purandare
    • 1
  • Ameya Puranik
    • 1
  • Venkatesh Rangarajan
    • 1
    Email author
  1. 1.Department of Nuclear Medicine and Molecular ImagingTata Memorial Hospital, Homi Bhaba National Institute (HBNI)MumbaiIndia
  2. 2.Department of Surgical OncologyTata Memorial Hospital, Homi Bhaba National Institute (HBNI)MumbaiIndia

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