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Outcomes in Thyroid Cancer:
What Factors are Important?

Copyright NYCRIS 2001. Extracts from these pages may be reproduced provided the source is fully acknowledged.   Return to AUDIT PROJECTS.

Thyroid Audit Report
30 Jun 2004 Executive Report
30 Jun 2004 - Thyroid Cancer Guidelines Summary
30 Jun 2004 - Thyroid Literature Review
30 Jun 2004 - Acknowledgements
30 Jun 2004 - Additional Analyses (Appendices)
30 Jun 2004 - Evaluation Form (to fax or send back)

Calendar of Events
20 March 2002 - Steering Group Meeting - Agenda - Notes - Presentation
Draft Proforma, Pilot Analysis (+ results), Questionnaire Analyses - Oncologist, Consultant, MDT (+ results)
18 July 2001 - Steering Group Meeting - Agenda - Notes - Presentation1 - 2
15 May 2001 - Steering Group Meeting - Agenda - Notes - Presentation1 - 2
08 Mar 2001 - Steering Group Meeting - Agenda - Notes - Presentation

14 June 2002 - Data Collection Proforma  (final)
18 July 2001 - Protocol  (draft)
15 Oct 2001 - Data Collection Proforma  (draft)
01 May 2002 - Questionnaires - Consultant - Oncologist - MDT
27 May 2002 - Data Collection proforma  (draft)
27 June 2002 - Latest version of Data Collection proforma   for comment


The study is looking at two key questions:

  • What really makes a difference to outcome and/or the decisions a team makes about management? Outcomes include:

    • cause-specific death,
    • overall and disease free survival,
    • early side effects of radioiodine treatment,
    • distant and local recurrence,
    • recurrent laryngeal nerve damage,
    • hypoparathyroidism.

  • Is there a disparity between actual management and guidelines? - a detailed audit of key features in guidelines e.g. pre-operative assessment and how treatment is given.

A retrospective review and a clinician questionnaire about management of patients with thyroid cancer will be employed.

The rationale agreed at the start of the project is given below.

Thyroid cancer is a relatively uncommon cancer; in the Northern and Yorkshire region there are around 120 cases annually. The prognosis for thyroid cancers is generally good, with middle aged adults with differentiated thyroid carcinoma showing a 10 year survival rate of 80-90%, overall.

Management of differentiated thyroid cancer may be by surgery alone or surgery followed by radio iodine I 131 ablation. Suppressive doses of T4 are given after removal of the tumour.

There are indications that there are variations in practice with possible sub-optimal treatment. The results of previously published studies suggest that there may be deficiencies in practice (Kumar et al 2001) and that the UK lags behind most other European countries in terms of 5-year survival (Teppo and Hakulinen). The evidence base relating to the management of thyroid cancers is limited to retrospective studies, there being no good-quality prospective clinical trials.

In the UK, The British Thyroid Association has recently published guidelines for the management of thyroid cancer. The guidelines were produced with the objectives of improving and standardising thyroid cancer management.

The audit currently being conducted by NYCRIS is of management of thyroid cancer in 1998 and 1999, which predates publication of the national guidelines.


Kumar H, Daykin J, Holder R, Watkinson JC, Sheppard MC, Franklyn JA. An audit of the management of differentiated thyroid cancer in specialist and non-specialist clinic settings. Clin Endocrinology 2001, 54: 719-23

Teppo L, Hakulinen T, and Eurocare Working Group. Variation in survival of adult patients with thyroid cancer in Europe (Eur J Cancer 1998. 34:2238-52

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