Updates in Surgery

, Volume 70, Issue 1, pp 121–127 | Cite as

Association of tumor size and focality with recurrence/persistence in papillary thyroid cancer patients treated with total thyroidectomy along with radioactive-iodine ablation and TSH suppression

  • Misbah Khan
  • Aamir Ali Syed
  • Amina Iqbal Khan
  • Syed Raza Hussain
  • Namra Urooj
Original Article


Locoregional recurrence is common in papillary thyroid cancer PTC and an optimal surgical treatment with respect to the multifocal nature of the disease stays controversial. It is a retrospective analytical study design. 209 diagnosed PTCs managed at our institute were grouped into macro-PTC with a size of dominant focus >1 cm (unifocal n = 106 and multifocal n = 64) and micro-PTMC if size of all foci was <1 cm; (unifocal n = 16 and multifocal PTMC n = 23). The primary endpoint is recurrence and tumor free survival in each of the four groups. Secondary endpoint is an assessment of a benefit of completion total thyroidectomy in terms of assignment of true focal status to an individual’s PTC. The median follow-up was 4.1 years. Upon completion thyroidectomy, the tumor focality changed to multifocal in 31.4% of macro-PTC and 60% of micro-PTMC. Multifocality was an independent risk factor for recurrence, OR 2.41 for macro (CI 1.14–5.11), and 3.48 for micro-multifocal PTMC (CI 1.19–10.2). Disease free survival patterns on Kaplan–Meier’s plots were alike for micro- and macro-unifocal groups, and similarly stayed comparable among the two multifocal groups. Our analysis showed that tumor multifocality rather than size is the significant factor determining prognosis; hence, total thyroidectomy is indicated for an optimal assessment of true focality in micro-PTC.


Multifocal papillary Thyroid cancer Micro-papillary thyroid cancer Tumor recurrence Recurrence free survival 



The authors thank Dr. Farhana Badar, clinical research scientist for her help in the statistical analysis and Dr. Sana Syed Assistant Professor of Neurology at Tufts Medical Center and Clinical Translational Research Fellow at Pfizer for the help in draft editing.

Compliance with ethical standards

Source of funding

This research did not receive any grant for its conduction or completion by any source.

Conflict of interest

The Authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported. The authors alone are responsible for the content and writing of the paper.

Research involving human participants and/or animals

This study does not involve any kind of animal related contacts or experiments by any of the listed authors.

Informed consent

The requirement for informed consent for this study was waived off by the Institution review board, due to it’s retrospective nature, data anonymization and no direct contact with the study subjects.


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Copyright information

© Italian Society of Surgery (SIC) 2017

Authors and Affiliations

  1. 1.Department of Surgical OncologyShaukat Khanum Memorial Cancer Hospital and Research Centre, SKMCH & RCLahorePakistan

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