Aims: This retrospective audit aimed to analyze the presentation, management strategies, and follow-up protocols of thyroid cancer patients within Northern Adelaide Local Health Network (NALHN) from 2017 to 2021. Specific objectives included evaluating initial detection methods, nodule characteristics, and adherence to American Thyroid Association (ATA) guidelines in surgical interventions, risk stratification and TSH suppression therapy, utilization of radioactive iodine (RAI) therapy, and post-therapy monitoring practices [1,2].
Methods: Data were extracted from medical records, electronic databases, radiology reports, and pathology records. Patients’ demographics, initial presentation details, imaging results, histopathological findings on fine needle aspirate and surgical specimen were examined, and surgical procedures and post-operative management were reviewed against the ATA guidelines.
Results: Of 161 screened patients, 97 met inclusion criteria. The most common initial presentations were asymptomatic palpable thyroid nodules (n=35) and incidentally found nodules on imaging (n=31). Most nodules were 1-4 cm in size (n=66) and larger than 4cm (n=17). Surgical interventions included hemithyroidectomy (61.9%) and total thyroidectomy (37.1%), with significant rates of completion thyroidectomy (n=47). ATA risk stratification was inadequately documented in a substantial proportion of cases (23/97). RAI therapy correlated with ATA risk stratification, with 100% rates in high- and intermediate-risk cases but lower in low-risk patients (51.2%). 95.8% of patients had TSH suppression on levothyroxine, but 21.7% were without initial ATA risk stratification, and 25.0% without an initial corresponding TSH goal. Thyroglobulin monitoring varied widely, with only 85.3% of patients having post-operative thyroglobulin levels obtained with TSH-stimulation, and large proportion of patients had their first post-operative ultrasound 12 months after surgery (27/97).
Conclusion: This audit identified areas for improvement in documenting ATA risk stratification, ensuring adherence to guidelines for surgeries performed, and standardizing post-operative monitoring practices. These findings underscore the need for consistent application of evidence-based guidelines to optimize the management of thyroid cancer patients at NALHN.