Risk of Advanced Papillary Thyroid Cancer in Obese Patients

Objective: To determine if increasing body mass index (BMI) is associated with more aggressive disease and adverse surgical outcomes in patients with papillary thyroid cancer (PTC).;Design: Retrospective review of a prospective database.;Setting: Single academic tertiary care center.;Patients: A total of 443 patients over age 18 who underwent total thyroidectomy for PTC from January 1, 2004 to March 31, 2011 were included in the analysis. Patients were organized into four BMI groups: normal (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), obese (30-39.9 kg/m2), and morbidly obese (¡Ý40 kg/m2).;Main Outcome Measures: Disease stage at presentation; histological subtype; duration of anesthetic induction and extubation; duration of surgery; surgical complications; length of hospital stay, and American Society of Anesthesiology Classification (ASA). Results: Ages ranged from 18-89. Greater BMI was associated with more advanced disease stage at presentation (p<0.0001) and with more aggressive PTC histopathology (p=0.027). Morbidly obese patients presented more frequently with stage III or stage IV disease (OR 3.67, p<0.0001). Greater BMI was also associated with longer duration of anesthetic induction (p<0.01), increased length of stay (p<0.001), and higher ASA classification (p<0.001). Duration of surgery was not associated with BMI. There was a trend towards larger tumors with increasing BMI (p=0.06). Obese BMI was associated with more preoperative vocal cord paralysis due to local invasion (OR 9.21, p=0.001).;Conclusions: Obese patients present with more advanced stage and more aggressive forms of papillary thyroid cancer. This suggests that obese patients should be screened for thyroid cancer.