Hemithyroidectomy or Total-Thyroidectomy in 'Low-risk' Thyroid Cancers

NCT ID: NCT05604963

Last Updated: 2025-05-11

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

456 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-02-14

Study Completion Date

2031-07-31

Brief Summary

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This is a multi-centre, randomised, non-inferiority, phase III study in patients with low risk differentiated thyroid cancer.

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 HT for thyroid problems and are then subsequently diagnosed with low risk DTC will be randomised 1:1 to undergo surveillance 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) but no surgery performed will be randomised 1:1 to have either a hemi-thyroidectomy OR a single-stage total thyroidectomy.

The overall aim of the trial is to determine whether hemithyroidectomy is an acceptable and cost-effective surgical procedure compared to total thyroidectomy in low risk thyroid cancer. Overall, 456 patients will be recruited to the trial. Patients will be initially be followed up post-surgery then 12 monthly for 6 years.

Detailed Description

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Conditions

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Differentiated Thyroid Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Group 1: Two-stage Completion Thyroidectomy

Patients randomised to this arm will undergo a 2nd operation to remove the remaining thyroid lobe.

Group Type ACTIVE_COMPARATOR

Total Thyroidectomy

Intervention Type PROCEDURE

Total Thyroidectomy - surgical removal of entire thyroid gland

Group 1: Surveillance

Patients randomised to this arm will have no 2nd surgery and proceed directly to follow-up visits.

Group Type NO_INTERVENTION

No interventions assigned to this group

Group 2: Hemi-thyroidectomy

Patients randomised to this arm will have a single HT operation to remove thyroid lobe with the tumour.

Group Type EXPERIMENTAL

Hemithyroidectomy

Intervention Type PROCEDURE

Hemithyroidectomy - surgical removal of partial thyroid gland

Group 2: Total Thyroidectomy

Patients randomised to this arm will have a single TT operation to remove the entire thyroid gland.

Group Type ACTIVE_COMPARATOR

Total Thyroidectomy

Intervention Type PROCEDURE

Total Thyroidectomy - surgical removal of entire thyroid gland

Interventions

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Total Thyroidectomy

Total Thyroidectomy - surgical removal of entire thyroid gland

Intervention Type PROCEDURE

Hemithyroidectomy

Hemithyroidectomy - surgical removal of partial thyroid gland

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

• Aged 16 or over

Papillary thyroid cancer:

* pT1b-2 (≤4cm) irrespective of molecular genetic markers
* R0 resection (clinically excised but microscopic R1 resected tumours at discretion of the local MDT)
* cN0 or pN0, pNX \& pN1a (≤5 foci, no extranodal spread)
* Confined to thyroid or minimal extrathyroidal extension
* No higher risk histological variants on morphology (small foci allowed at the discretion of the local MDT)
* No angioinvasion NB. PTC is still eligible where microscopic invasion of endothelial lined small capillary vascular spaces and lymphatic channels are present. It becomes ineligible in the rare instances when there is definite invasion of a larger vascular structure such as a vein with smooth muscle in its wall.
* Encapsulated FVPTC with capsular invasion only
* Micro-PTC (≤1cm)

* multifocal
* unifocal with pN1a (≤5 foci; no extranodal spread)

Follicular thyroid cancer (FTC), including oncocytic or Hürthle cell carcinoma:

* 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)
* Confined to thyroid or minimal extrathyroidal extension


* Aged 16 or over
* 'low risk' differentiated thyroid cancer confirmed by cytology or core biopsy.
* cT1b-2 irrespective of molecular genetic markers
* cN0
* Contralateral lobe without suspicious nodule(s) (U2, or U3/U4 with Thy2 on FNAC)

Exclusion Criteria

* \>4cm
* unifocal pT1a (≤1cm) PTC or FTC (unless pN1a as above)
* NIFTP (non-invasive follicular thyroid neoplasm with papillary-like nuclear features)
* Anaplastic, poorly differentiated or medullary thyroid carcinoma
* R2
* gross extrathyroidal extension
* pT4 or macroscopic tumour invasion of loco-regional tissues or structures
* pN1a with \>5 foci or extranodal spread
* pN1b
* M1
* 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
* FTC, including oncocytic or 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 (DTC on cytology or after core biopsy, who has not had prior thyroid surgery yet)


• M1
Minimum Eligible Age

16 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute for Health Research, United Kingdom

OTHER_GOV

Sponsor Role collaborator

University College, London

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Leighton Hospital

Crewe, Cheshire, United Kingdom

Site Status RECRUITING

Aberdeen Royal Infirmary

Aberdeen, , United Kingdom

Site Status RECRUITING

Royal United Hospital

Bath, , United Kingdom

Site Status NOT_YET_RECRUITING

Queen Elizabeth Hospital

Birmingham, , United Kingdom

Site Status RECRUITING

University Hospitals Bristol and Weston NHS Foundation Trust

Bristol, , United Kingdom

Site Status RECRUITING

Addenbrooke's Hospital

Cambridge, , United Kingdom

Site Status RECRUITING

University Hospital of Wales

Cardiff, , United Kingdom

Site Status RECRUITING

Colchester Hospital

Colchester, , United Kingdom

Site Status RECRUITING

Royal Derby Hospital

Derby, , United Kingdom

Site Status RECRUITING

Ninewells Hospital

Dundee, , United Kingdom

Site Status RECRUITING

NHS Lothian

Edinburgh, , United Kingdom

Site Status RECRUITING

Royal Devon and Exeter Hospital

Exeter, , United Kingdom

Site Status RECRUITING

Forth Valley Royal Hospital

Falkirk, , United Kingdom

Site Status RECRUITING

Medway Maritime Hospital

Gillingham, , United Kingdom

Site Status RECRUITING

NHS Greater Glasgow & Clyde

Glasgow, , United Kingdom

Site Status RECRUITING

Ipswich Hospital

Ipswich, , United Kingdom

Site Status RECRUITING

Leicester Royal Infirmary

Leicester, , United Kingdom

Site Status RECRUITING

Liverpool University Hospitals

Liverpool, , United Kingdom

Site Status RECRUITING

Guy's Hospital

London, , United Kingdom

Site Status RECRUITING

Lister Hospital

London, , United Kingdom

Site Status RECRUITING

Northwick Park Hospital

London, , United Kingdom

Site Status RECRUITING

St George's Hospital

London, , United Kingdom

Site Status RECRUITING

The Royal Marsden Hospitals

London, , United Kingdom

Site Status RECRUITING

University College London Hospital

London, , United Kingdom

Site Status NOT_YET_RECRUITING

Luton and Dunstable University Hospital

Luton, , United Kingdom

Site Status RECRUITING

Northampton General Hospital

Northampton, , United Kingdom

Site Status RECRUITING

Norfolk and Norwich University Hospital

Norwich, , United Kingdom

Site Status RECRUITING

Nottingham University Hospitals NHS Trust

Nottingham, , United Kingdom

Site Status NOT_YET_RECRUITING

Derriford Hospital

Plymouth, , United Kingdom

Site Status RECRUITING

University Hospitals Dorset NHS Foundation Trust

Poole, , United Kingdom

Site Status RECRUITING

Queen Alexandra Hospital

Portsmouth, , United Kingdom

Site Status RECRUITING

Royal Berkshire Hospital

Reading, , United Kingdom

Site Status RECRUITING

Glan Clwyd Hospital (Betsi Cadwaladr University Health Board)

Rhyl, , United Kingdom

Site Status RECRUITING

Sheffield Teaching Hospitals

Sheffield, , United Kingdom

Site Status RECRUITING

Musgrove Park Hospital

Taunton, , United Kingdom

Site Status RECRUITING

Countries

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United Kingdom

Central Contacts

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Jeannie Chamberlain (UCL Cancer Trials Centre)

Role: CONTACT

020 3108 4875

Other Identifiers

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UCL/136591

Identifier Type: -

Identifier Source: org_study_id

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