Thyroid cancer is becoming increasingly prevalent worldwide. In the UK alone, the incidence of thyroid cancer has increased by 175% since the early 1990s.1 However, disease-specific mortality from thyroid cancer has not shown a corresponding rise and remains relatively stable with an excellent prognosis for the majority of patients.1 Whilst the exact reason for these trends is unclear and may be multifactorial, increasing ease of access to sophisticated imaging techniques coupled with advancement in diagnostic pathological and molecular genetics of thyroid cancer are likely to explain much of the observed change.2 As such, there is a move towards identification of small volume, low-risk cases which were previously undetected and pose little threat to patients.3

Over the past decade, with an improved understanding of the biology of disease, there has been a significant evolution in UK and international guidelines on the management of differentiated thyroid cancer (DTC). In comparison to the historical approach of a total thyroidectomy combined with radioactive iodine for most patients with DTC, guidelines now support a move towards a more conservative, risk adapted model.4

The British Thyroid Association (BTA) published updated guidelines in 2014 with a considerable emphasis on personalised decision making rather than a one-size fits all approach.4 This refers to tailoring treatment plans within a multi-disciplinary team framework, based on consideration of tumour and patient factors, weighing up the potential benefits and detrimental effects of any intervention.4 It aims to minimise potential harm from overtreatment in a majority of low-risk cases, while appropriately treating and monitoring patients with higher risk disease.4 For patient groups without any of the following clinical or histopathological parameters: tumour >4 cm, multifocal or bilateral disease, extrathyroid extension, clinically or radiologically involved lymph nodes, distant metastases, and/or family disease; a diagnostic thyroid lobectomy can now be considered.4 On publication of these updated guidelines, our group retrospectively analysed a historic cohort of patients and predicted that a significant number of patients would become eligible for less aggressive treatment.5

The aim of this study was therefore to evaluate the actual impact of the updated guidelines in a UK centre, by analysing the management of patients with DTC presenting to a regional MDT before and after the guideline was introduced in 2014.