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What is the care pathway of patients who undergo thyroid surgery in France and its potential pitfalls? A national cohort
  1. Muriel Mathonnet1,
  2. Anne Cuerq2,
  3. Christophe Tresallet3,
  4. Jean-Christophe Thalabard4,
  5. Elisabeth Fery-Lemonnier5,
  6. Gilles Russ6,
  7. Laurence Leenhardt6,
  8. Claude Bigorgne7,
  9. Philippe Tuppin2,
  10. Bertrand Millat8,
  11. Anne Fagot-Campagna2
  1. 1Hospital of Limoges, Limoges, France
  2. 2Caisse Nationale d'Assurance Maladie des Travailleurs Salariés, Paris, France
  3. 3Department of General, Visceral and Endocrine Surgery, Pitié-Salpêtrière Hospital, Paris, France
  4. 4Unit of Gynecology and Endocrinology, Cochin Hospital, Paris, France
  5. 5Ministry of Health, Paris, France
  6. 6Department of Thyroid Diseases and Endocrine Tumors, Pitié Salpêtrière Hospital, University Paris VI, Institut E3M, Paris, France
  7. 7Department of Pathology, La Pitié Salpétrière Hospital, Paris, France
  8. 8Lapeyronie Hospital, Paris, France
  1. Correspondence to Dr Anne Fagot-Campagna; anne.fagot{at}cnamts.fr

Abstract

Context The rate of thyroid cancer is increasing in France, as well as concerns about overdiagnosis and treatment.

Objectives To examine the care pathway of patients who undergo thyroid surgery in France and detect potential pitfalls.

Design A large observational study based on medical reimbursements, 2009–2011.

Setting Data from the Sniiram (National Health Insurance Information System).

Patients Patients with thyroid surgery in 2010, classified into 4 groups: thyroid cancer, benign nodule, goitre or multiple nodules, other (hyperthyroidism, head–neck cancer).

Main outcome measures Medical investigations during, prior and after thyroidectomy.

Results A total of 35 367 patients underwent surgery (mean age 51 years, 80% women): 17% had a reported diagnosis of thyroid cancer, 20% benign nodule, 38% goitre or multiple nodules and 25% another diagnosis. The ratio of thyroidectomies with cancer over thyroidectomies with benign nodule was 0.8 and varied across regions. In the year preceding surgery, 82% of patients had an investigation by thyroid ultrasonography, 21% thyroid scintigraphy, 34% fine-needle aspiration cytology, 40% serum calcitonin assay and 54% serum calcium assay. In the following year, all patients with total thyroidectomy and 44% of patients with partial thyroidectomy and a diagnosis of benign nodule were taking thyroid hormone therapy. 100 patients had been reoperated for a compressive haematoma and 63 died during the first month, half of whom had been operated for cancer. Mean rates of recurrent laryngeal nerve injury and hypocalcaemia (requiring blood tests plus treatments within 4–12 months) were estimated at 1.5% and 3.4%, respectively, and were higher in the cancer group (2.3% and 5.7%).

Conclusions This almost nationwide study demonstrates the suboptimal management of patients prior to thyroidectomy in France. It suggests overdiagnosis and potential harms to patients, and calls for a review of the relevance of thyroidectomy, particularly with regard to microcancers.

  • SURGERY
  • overdiagnosis
  • cancer

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Footnotes

  • Contributors MM, AC, CT, J-CT, EF-L, PT, BM and AF-C were involved in study concept and design. MM, AC, CT, J-CT, EF-L, GR, LL, CB, PT, BM and AF-C were involved in interpretation of data. MM, AC and AF-C were involved in drafting of the manuscript. MM, AC, CT, J-CT, EF-L, GR, LL, CB, PT, BM and AF-C were involved in critical revision of the manuscript for important intellectual content. AC was involved in statistical analysis. MM, BM and AF-C were involved in study supervision.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Commission nationale informatique et libertes (CNIL).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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