Medicare confirms that there are too many unjustified thyroid ablations. The clinical recommendations which precede the operation are little respected.
“There are too many thyroidectomies for benign nodules in France,” explains Dr Pierre Fender, national medical advisor deputy to Health Insurance. The Que Choisir Santé magazine recently pointed out “these excess scalpels”, which put patients at unnecessary risk. This Tuesday, the Health Insurance notably showed, with supporting figures, that French doctors do not follow the recommendations from learned societies to the letter before deciding on an intervention.
40% of patients operated without prior fine needle aspiration
Its analysis focused on General Diet patients with a thyroid nodule without hyperthyroidism operated on in 2010, and on examinations carried out in the 12 months preceding and following the operation. The objective of the work was to assess whether the partial or total ablations of the thyroid were not too systematic and were well preceded by the necessary examinations.
While the recommendations agree on the fact that fine needle aspiration, that is to say the puncture with a fine needle of the cells contained in the nodule, is one of the standard examinations before to operate, is not performed frequently enough. The examination is carried out only in 40% of the operated patients: respectively 44% in the event of cancer and 34% in the event of benign nodule.
However, greater recourse to this examination would make it possible to avoid total ablations of the thyroid which are unnecessary and not without complications. Indeed, 4% of operated patients have repercussions on the functioning of a vocal cord which may require speech therapy sessions. In addition, according to Health Insurance, these surgical practices are very diverse from one region to another. Some, like Languedoc Roussillon, have an over-representation of benign nodule operations.
Listen to Dr Pierre Fender, National medical advisor assistant to health insurance: “There is a link between areas that have excess thyroid ablation for benign nodule and those that have insufficient use of fine needle aspiration. “
Health insurance data therefore show that there is a need to harmonize practices, especially since in 1/4 of the cases of benign nodules operated on, it is a total thyroidectomy that is performed, with the consequences that this induces, in particular a lifelong hormonal treatment.
Better inform doctors and patients
In view of the results of this study, the Health Insurance is therefore making some proposals in order to improve the patient care pathway and above all to better supervise thyroid ablations in France. The CNAM will first of all refer the matter to the Haute Autorité de Santé (HAS) on the need to clarify for the various health professionals concerned the course to follow after discovery of a thyroid nodule, but also on the choice of surgical technique ( total or partial thyroidectomy). Currently, several recommendations exist, however from learned societies with sometimes different approaches to the preoperative care pathway.
Listen to Dr Pierre Fender : ” There is an urgent need to refer the matter to the HAS so that it can issue definitive recommendations for the management of these nodules. “
Health Insurance also plans to ask HAS to develop decision support tools that it could promote to patients in order to enable them to make an informed choice when they are faced with several options with benefits and risks.
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