Abstract
We thank Professors Kuru and Topgul for their letter. After re-review of our references, they are correct in their contention that the statement about total thyroidectomy for patients with smaller tumors in older individuals is incorrectly referenced. In fact, going back to the original ATA guidelines published in 2006, the almost identical statement was also incorrectly referenced, and this seems unfortunately to have been due to our errors when we drafted the manuscript. However, we do stand by our statement that “older age (>45 years) may also be a criteria for recommending near total or total thyroidectomy even with tumors <1–1.5 cm, because of higher recurrence rates in this age group.” We should have also included the explicit statement that survival might also be improved with total thyroidectomy in this group as well, regardless of age, in patients with tumors ≥1.0 cm (1). The assumption can be made that if survival is improved then recurrence rates are likely also lowered, since many patients who die of thyroid cancer suffer a recurrence first (2). We agree that data specifically showing decreased recurrence rates and/or improved survival in the subgroup of older patients with smaller tumors are lacking. The most appropriate references for the statement, including effects of age on survival, are below (3,4). We apologize to our readers for any confusion that the erroneous referencing may have caused. These statements will be reviewed and modified as appropriate in the next iteration of the guidelines which is currently in process.