OBJECTIVES : Over the past 40 years, the incidence of thyroid cancer has nearly tripled. For most thyroid cancer, surgical management is mainstay of treatment. Most tradeoffs between the two surgical options (lobectomy and total thyroidectomy) are preference sensitive, yet patients’ perspectives have not been well studied. We designed and executed a discrete-choice experiment (DCE) to quantify benefit-risk tradeoffs relevant to surgical options for low-risk thyroid cancer.

METHODS : Adult patients requiring surgery for low-risk thyroid cancer or a thyroid nodule were invited to participate in a web-based DCE survey. Participants completed 6 choice tasks in which they were asked to choose between experimentally-designed surgical options with varying levels of risk of nerve damage (1%, 9%, 14%), risk of hypocalcemia (0%, 3%, 8%), risk of requiring a second surgery (0%, 40%), need for daily thyroid hormone supplementation (yes, no), and cancer recurrence (1%, 3%, 7%). Random-parameters logit models fit participants’ choices as a function of surgical outcomes. The resulting estimates were used to evaluate preferences for surgical profiles representing lobectomy and total thyroidectomy.

RESULTS : From 2017-18, 150 patients were enrolled. Median age was 58 years; 80% were female. Internal validity checks indicated high-quality data. On average, when inferring patients’ preferences for assumed clinical profiles representing lobectomy and total thyroidectomy, patients would generally favor total thyroidectomy largely due to their negative views about an assumed 40% risk of requiring a second surgery with lobectomy. However, if the risk of needing a second surgery after lobectomy can be reduced to 31% or less, the average patient would begin to favor lobectomy over total thyroidectomy.

CONCLUSIONS : Patients facing real-world decisions about surgery for thyroid cancer will encounter varying levels of surgery-related risks due to tumor characteristics and experience of their surgeon. Individualized risk and preference assessments are essential to ensuring high-quality medical decision-making for low-risk thyroid cancer.