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Less is More: The Impact of Multidisciplinary Thyroid Conference on the Treatment of Well-Differentiated Thyroid Carcinoma.

Less is More: The Impact of Multidisciplinary Thyroid Conference on the Treatment of Well-Differentiated Thyroid Carcinoma.
Author Information (click to view)

Moore MD, Postma E, Gray KD, Ullmann TM, Hurley JR, Goldsmith S, Sobel VR, Schulman A, Scognamiglio T, Christos PJ, Hassett E, Luick J, Whitehall D, Zarnegar R, Fahey TJ,


Moore MD, Postma E, Gray KD, Ullmann TM, Hurley JR, Goldsmith S, Sobel VR, Schulman A, Scognamiglio T, Christos PJ, Hassett E, Luick J, Whitehall D, Zarnegar R, Fahey TJ, (click to view)

Moore MD, Postma E, Gray KD, Ullmann TM, Hurley JR, Goldsmith S, Sobel VR, Schulman A, Scognamiglio T, Christos PJ, Hassett E, Luick J, Whitehall D, Zarnegar R, Fahey TJ,

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World journal of surgery 2017 10 20() doi 10.1007/s00268-017-4308-9

Abstract
BACKGROUND
In 2006, a multidisciplinary thyroid conference (MDTC) was implemented to better plan management of thyroid cancer patients at our institution. This study assessed the clinical impact of a MDTC on radioactive iodine (RAI) treatment patterns.

METHODS
A prospective database (2003-2014) collected patient and tumor characteristics, RAI doses, and tumor recurrences. Patients treated with total thyroidectomy for differentiated thyroid carcinoma ≥1 cm were stratified based on American Thyroid Association (ATA) risk classification. RAI regimens were compared before initiation of MDTC (2003-2005, n = 88), after establishment of MDTC (2007-2009, n = 95), and after the release of 2009 ATA guidelines (2011-2014, n = 181). RAI doses were defined as low (≤75 mCi), intermediate (76-150 mCi), and high (>150 mCi).

RESULTS
There was a significant decrease in the number of patients who received high-dose RAI after implementation of MDTC compared to before initiation of MDTC in the intermediate and high-risk patient groups (p = 0.04 and p < 0.01) without an associated increase in tumor recurrence (11 vs. 7%, p = 0.74). On multivariable analysis, presentation of a patient at MDTC was a negative predictor for receiving high-dose RAI (p = 0.002). As might be expected, there was also a significant decrease in use of RAI after the 2009 ATA guidelines were issued compared to after implementation of MDTC (p < 0.01). CONCLUSION
In conjunction with implementation of a thyroid malignancy multidisciplinary conference, we observed significantly decreased postoperative dosing of RAI without increased tumor recurrence. The 2009 ATA guidelines were associated with a further decrease in RAI administration. Treatment for patients with thyroid carcinoma is optimized by a multidisciplinary approach.

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