Low-Risk Papillary Thyroid Cancer: Treatment De-Escalation and Cost Implications

Christina M. Paluskievicz, Daniel R. Chang, Kyle W. Blackburn, Douglas J. Turner, Kashif M. Munir, C. Daniel Mullins, John A. Olson, Yinin Hu

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Introduction: The American Thyroid Association (ATA) updated consensus guidelines in 2015 for radioactive iodine (RAI) and resection for low-risk papillary thyroid cancer. The objective of this study was to describe the evolution of institutional practice patterns and estimate the cost implications of these trends. Materials and methods: Patients with cT1-T2N0 papillary thyroid cancer were identified via an institutional tumor registry. Incidences of total thyroidectomy or RAI were tracked longitudinally using cumulative sum. Real-world costs for RAI and each surgical encounter were adjusted for inflation and standardized to national average costs from National Inpatient Sample cost data. Results: Sixty-one patients met inclusion criteria between 2007 and 2018. Among these, 28 patients underwent total thyroidectomies and received RAI treatments based on criteria pre-dating the 2015 ATA guidelines. Cumulative sum revealed significant decreases in the rate of total thyroidectomy following May 2015 (15.8% versus 59.5%, P = 0.002) and RAI following March 2013 (3.0% versus 32.1%, P = 0.002). There were no locoregional recurrences in either period. The average cost savings attributable to these institutional practice changes was $1580 per patient. Conclusions: De-escalation in surgical and RAI utilization for low-risk papillary thyroid cancer according to 2015 ATA guidelines is associated with a substantial decrease in real-world costs.

Original languageEnglish
Pages (from-to)273-280
Number of pages8
JournalJournal of Surgical Research
StatePublished - Jul 2022


  • Cost
  • Papillary thyroid cancer
  • Thyroidectomy


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