Management of Well Differentiated Thyroid Cancers (DTCs)

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Are you part of a regular multi-disciplinary team (MDT) that discusses benign and malignant thyroid cases?

Yes

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Which deanery/CCG does your MDT cover?

How many thyroid surgeries (lobectomies/total thyroidectomies) do you perform, on average, per year?

Which guidelines does your local thyroid MDT utilise in constructing the management plan for thyroid cancer patients?

The 2014 British Thyroid Association (BTA) guidelines

The 2015 American Thyroid Association (ATA) guidelines

The American Joint Committee on Cancer (AJCC) 8th Edition (2017)

The AMES system guidelines

The AGES system guidelines

A combination of the above (If so, please specify below in the other box)

Other:

What specific features would your local MDT consider as risk factors when risk stratifying a patient at the time of diagnosis?

Age >45 years old

Age >55 years old

Gender

Tumour histology

Tumour size >1cm

Tumour size >4cm

Extrathyroidal extension - T3a (Tumour >4cm limited to thyroid)

Extrathyroidal extension - T3b (Gross extrathyroidal extension invading only strap muscles from a tumour of any size)

Central nodal involvement - any number of nodal involvement

Central nodal involvement - >5 nodal involvement

The next few questions are based on theoretical cases and we would like to know the most likely decision your MDT would reach for each of the cases

A 38 year old female, with no past medical history (PMH) presents with a thyroid swelling. She undergoes an ultrasound and fine needle aspiration and cytology (USS & FNAC), which demonstrates a solitary right sided 2cm nodule, with NO other abnormalities in the thyroid or neck. The FNAC comes back as a Thy5. What would your local MDT suggest for management?

Lobectomy of the affected side

Total thyroidectomy (TT) alone

TT followed by radio-iodine ablation (RAI)

TT and unilateral central neck dissection (level 6)

TT and bilateral central neck dissection (level 6)

TT and central neck dissection (uni/bilateral level 6) followed by RAI

Other:

Clear selection

A 40 year old male, with no PMH has a USS & FNAC for a solitary 3cm thyroid nodule, which comes back as Thy3. He undergoes a diagnostic lobectomy, which shows a classical papillary thyroid cancer (PTC). Subsequent staging USS of the neck shows no other nodules in the contralateral side or any involved nodes. What would your local MDT suggest for management?

Continue surveillance (serial clinical and USS examinations)

Completion thyroidectomy alone

Completion thyroidectomy and central neck dissection (uni/bilateral level 6)

Completion thyroidectomy and central neck dissection followed by RAI

Other:

Clear selection

A 40 year old male, with no PMH has a USS & FNAC for a solitary 3cm thyroid nodule, which comes back as Thy3. He undergoes a diagnostic lobectomy, which shows a classical papillary thyroid cancer (PTC). Histology confirms the incidental removal of 4 lymph nodes, two of which show microscopic positivity (<3mm). What would your local MDT suggest for management?

Continue surveillance (serial clinical and USS examinations)

Completion thyroidectomy alone

Completion thyroidectomy and central neck dissection (uni/bilateral level 6)

Completion thyroidectomy and central neck dissection followed by RAI

Clear selection

A 42 year old, female, with no PMH, has a lobectomy for a Thy2, presumed colloid cyst, due to aesthetic reasons and discomfort (no compressive symptoms). The pathology comes back with 3 foci of intrathyroidal papillary microcarcinomas, the largest measuring 4mm. Post-operative USS does not show any other nodules on the contralateral side. What would your local MDT suggest for management?

Continue surveillance (serial clinical and USS examinations)

Completion thyroidectomy

Clear selection

A 42 year old, female, with no PMH, has a lobectomy for a Thy2, presumed colloid cyst, due to aesthetic reasons and discomfort (no compressive symptoms). The pathology comes back with 3 foci of intrathyroidal papillary microcarcinomas, the largest measuring 4mm. Post-operative USS shows several nodules, measuring 2cm maximum, on the contralateral side, classified as U2/3. FNAC of the nodules come back as Thy2. What would your local MDT suggest for management?

Continue surveillance (serial clinical and USS examinations)

Completion thyroidectomy

Clear selection

Finally, this part of the questionnaire relates to potential future surgical trials and your unit's capacity for patient recruitment

Are you currently involved in the recruitment of the IoN Trial?

Yes

Clear selection

If you are not involved in the IoN Trial, are you involved in any other RCT?

Not applicable

Yes, if so, please specify below

Other:

Would you and your local MDT be interested in being involved in a future surgical trial on the management of DTCs?

Yes

Maybe

Clear selection

Do you have access to research nurse(s)/staff to help with trial work?

Yes

Clear selection

Please only answer this question if you answered "no" to the previous question. Is there anything the NCRI can do to help facilitate your access to research nurse(s)/staff?

Are there any comments/suggestions/reservations you have on being involved in a future surgical trial?

Thank you!

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