Hemithyroidectomy or Total-Thyroidectomy in 'Low-risk' Thyroid Cancers (HoT)
Differentiated Thyroid Cancer
About this trial
This is an interventional treatment trial for Differentiated Thyroid Cancer
Eligibility Criteria
Group 1 (HT already performed prior to diagnosis) Inclusion criteria • Aged 16 or over Papillary thyroid cancer: pT1b-2 (≤4cm) irrespective of molecular genetic markers R0 resection (clinically excised but microscopic R1 resected tumours at discretion of the local MDT) cN0 or pN0, pNX & pN1a (≤5 foci, no extranodal spread) Confined to thyroid or minimal extrathyroidal extension No higher risk histological variants on morphology (small foci allowed at the discretion of the local MDT) No angioinvasion Encapsulated FVPTC with capsular invasion only Micro-PTC (≤1cm) multifocal unifocal with pN1a (≤5 foci; no extranodal spread) Follicular thyroid cancer (FTC), including oncocytic or Hürthle cell carcinoma: pT1b-2 (≤4cm) irrespective of molecular genetic markers - Minimally invasive, with capsular invasion +/- minimal (≤4 foci) vascular invasion (the latter is now called encapsulated angioinvasive and is at the discretion of the MDT) Confined to thyroid or minimal extrathyroidal extension Exclusion criteria >4cm unifocal pT1a (≤1cm) PTC or FTC (unless pN1a as above) non-invasive encapsulated FVPTC Anaplastic, poorly differentiated or medullary thyroid carcinoma R2 gross extrathyroidal extension pT4 or macroscopic tumour invasion of loco-regional tissues or structures pN1a with >5 foci or extranodal spread pN1b M1 Aggressive PTC with any of the following features: Widely invasive Poorly differentiated Anaplastic predominance of Tall cell, Columnar cell, Hobnail, Diffuse sclerosing and other higher risk variants FTC, including oncocytic or Hürthle cell cancer with any of the following features: Minimally invasive with extensive vascular invasion (now called encapsulated angioinvasive) (>4 foci) Widely invasive Poorly differentiated Anaplastic Group 2 (DTC on cytology or after core biopsy, who has not had prior thyroid surgery yet) Inclusion criteria Aged 16 or over 'low risk' differentiated thyroid cancer confirmed by cytology or core biopsy. cT1b-2 irrespective of molecular genetic markers cN0 Contralateral lobe without suspicious nodule(s) (U2, or U3/U4 with Thy2 on FNAC) Exclusion criteria • M1
Sites / Locations
- Addenbrooke's HospitalRecruiting
- Ninewells HospitalRecruiting
- NHS LothianRecruiting
- NHS Greater Glasgow & ClydeRecruiting
- Liverpool University HospitalsRecruiting
- Lister HospitalRecruiting
- Northwick Park HospitalRecruiting
- St George's HospitalRecruiting
- The Royal Marsden HospitalsRecruiting
- Norfolk and Norwich University HospitalRecruiting
- Sheffield Teaching HospitalsRecruiting
- Musgrove Park HospitalRecruiting
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Active Comparator
No Intervention
Experimental
Active Comparator
Group 1: Two-stage Completion Thyroidectomy
Group 1: Surveillance
Group 2: Hemi-thyroidectomy
Group 2: Total Thyroidectomy
Patients randomised to this arm will undergo a 2nd operation to remove the remaining thyroid lobe.
Patients randomised to this arm will have no 2nd surgery and proceed directly to follow-up visits.
Patients randomised to this arm will have a single HT operation to remove thyroid lobe with the tumour.
Patients randomised to this arm will have a single TT operation to remove the entire thyroid gland.