Thyroid cancer histological subtypes based on tumor size: National perspective

Head Neck. 2020 Sep;42(9):2257-2266. doi: 10.1002/hed.26159. Epub 2020 Apr 10.


Background: Thyroid tumor size is an important prognostic factor. The aim of this study is to examine the histological subtypes and management of thyroid cancer based on tumor size (≤4 cm vs >4 cm).

Methods: Retrospective cohort study utilizing the National Cancer Database, 2004-2014.

Results: A total of 152 387 patients were included, 13 614 (8.9%) of whom had a tumor size >4 cm. Histological subtypes of tumors >4 cm were: 69.6% papillary thyroid carcinoma, 17.5% FTC, 7.9% HCC, and 2.8% medullary thyroid carcinoma (MTC). High-volume hospitals for thyroid surgery were less likely to perform two-stage thyroidectomy, particularly for tumors ≤4 cm. Low-volume hospitals had a higher risk of staged thyroidectomy for MTC ≤4 cm (19.8%) compared with high-volume hospitals (8.7%) (P < .001).

Conclusions: This study describes the prevalence of thyroid cancer subtypes. In the era of a conservative approach to differentiated thyroid carcinoma, there could be a potential increase in the risk of staged thyroidectomy.

Keywords: hospital volume; medullary thyroid carcinoma; thyroid cancer; thyroid surgery; tumor size.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Humans
  • Retrospective Studies
  • Thyroid Neoplasms* / diagnosis
  • Thyroid Neoplasms* / pathology
  • Thyroid Neoplasms* / surgery
  • Thyroidectomy