Thyroid Preservation Trends in the Era of Molecular Testing

Introduction: With improved screening and imaging techniques, thyroid nodules have increasingly been identified. Out of concern patients with benign nodules would undergo unnecessary surgery, the American Thyroid Association (ATA) released updated guidelines in 2015 to encourage more conservative surgical intervention and incorporated molecular testing. The objective of this study is to determine thyroidectomy trends following the release of these guidelines.

Methods: The Military Health System Data Repository was queried for thyroidectomy current procedure terminology (CPT) codes for procedures performed between 2014–2021. Cases were grouped based on intention to preserve thyroid tissue (thyroid-preserving: CPT 60200, 60210, 60212, 60220, and 60225) or to completely remove thyroid tissue (non-preserving: CPT 60240, 60252, 60254, 60260, 60270, and 60271). Linear regression was used to determine rates of change, and Pearson correlations were performed.

Results: 13,235 thyroidectomies were performed in the study period (47% thyroid-preserving, 53% non-preserving), for an average of 1,654 thyroidectomies/year. There were 545 fewer thyroidectomies performed in 2021 compared to 2014, a 28% decrease. The annual decrease in thyroidectomies was 4.1% each year (r= -0.97, p< 0.0001). For thyroid-preserving surgeries, the annual decrease was 2.2% (r= -0.89, p=0.003). For non-preserving surgeries, the annual decrease was 5.7% (r= -0.97, p< 0.0001). These trends continued through the COVID19 pandemic.

Conclusions: The volume of thyroidectomies has decreased since the 2015 ATA guidelines, and complete thyroidectomies had a sharper decline than partial thyroidectomies. In the setting of increased identification of thyroid nodules, the presented data suggest a greater effort toward preserving thyroid tissue over time, likely from greater reliance on molecular testing and changes in Endocrinology practices.