Hemithyroidectomy or Total Thyroidectomy in 'low-risk' thyroid cancers
Low risk thyroid cancers
Patients will be identified via oncology multidisciplinary team meetings. There will be two sources of patients in the trial, with the same histological diagnoses and prognosis (i.e. recurrence risk): - Group 1: Patients who have already had a hemithyroidectomy for thyroid problems and are then subsequently diagnosed with low risk DTC will be randomised 1:1 to undergo surveillance (follow-up only) only OR a second operation to remove the rest of their thyroid gland (two-stage total thyroidectomy). - Group 2: Patients diagnosed with low risk DTC using cytology (Thy5) or core biopsy but no surgery performed will be randomised 1:1 to have either a hemi-thyroidectomy OR a single-stage total thyroidectomy. All thyroid surgeries performed on the trial will be as per the standard of care at the treating hospital.
Current key inclusion criteria as of 16/07/2025: Group 1 (Hemithyroidectomy already performed prior to diagnosis) 1. Aged 16 years or over 2. Papillary thyroid cancer (PTC): 2.1. pT1b-2 (≤4cm) irrespective of molecular genetic markers 2.2. R0 resection (clinically excised but microscopic R1 resected tumours at discretion of the local multidisciplinary team (MDT)) 2.3. cN0 or pN0, pNX & pN1a (≤5 foci, no extranodal spread) 2.4. Confined to thyroid or minimal extrathyroidal extension 2.5. No higher risk histological variants on morphology (small foci allowed at the discretion of the local MDT) 2.6. No angioinvasion 2.7. Encapsulated follicular variant of PTC with capsular invasion only 2.8. Micro-PTC (≤1cm) - multifocal - unifocal with pN1a (≤5 foci; no extranodal spread) 3. Follicular thyroid cancer and oncocytic/Hurthle cell carcinoma: 3.1. 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) 3.2. Confined to thyroid or minimal extrathyroidal extension Group 2 (Differentiated Thyroid Cancer on cytology/core biopsy, who has not had prior thyroid surgery yet) 1. Aged 16 or over 2. ‘low risk’ differentiated thyroid cancer confirmed by cytology or core biopsy. 3. cT1b-2 irrespective of molecular genetic markers 4. cN0 5. Contralateral lobe without suspicious nodule(s) (U2, or U3/U4 with Thy2 on FNAC) Eligibility criteria for nested sub-study on OpenClinica Participate’s web-based app (software): 1. Have a SMS enabled mobile phone or handheld tablet with web access 2. Are able to use the web-based app to complete the trial questionnaires without assistance Previous key inclusion criteria: Group 1 (Hemithyroidectomy already performed prior to diagnosis) 1. Aged 16 or over 2. Papillary thyroid cancer (PTC): 2.1. pT1b-2 (≤4cm) irrespective of molecular genetic markers 2.2. R0 res
Group 1 (Hemithyroidectomy already performed prior to diagnosis): 1. Tumour > 4cm 2. Unifocal pT1a (< = 1cm) papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC) (unless pN1a as listed in inclusion criteria) 3. Non-invasive encapsulated follicular variant of PTC 4. Anaplastic, poorly differentiated or medullary thyroid carcinoma 5. R2 resection 6. Gross extrathyroidal extension 7. pT4 or macroscopic tumour invasion of loco-regional tissues or structures 8. pN1a with > 5 foci or extranodal spread 9. pN1b 10. M1 11. 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 12. FTC and oncocytic/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 (Differentiated thyroid cancer on cytology or after core biopsy, who has not had prior thyroid surgery yet) 1. M1