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Thyroidectomy

General

A total thyroidectomy is ordinarily the primary treatment for differentiated thyroid carcinoma, medullary carcinoma, and anaplastic thyroid carcinoma, based on certain criteria. During the same operation, the pre and paratracheal lymph nodes are removed (central lymph node dissection). 

If pathological lymph nodes are found in the lateral neck region before or during the operation, a modified radical lymph node dissection should performed in addition. This involves preservation of nerves, vessels, and muscles in the area.

The next level of treatment for differential thyroid carcinoma is usually ablation with radioactive iodine (131I). The patient will have life-long treatment of thyroid hormone suppression.

A hemithyroidectomy consists of a lobectomy as well as removal of the isthmus and pyramidal lobe, if present.

Indications

Total thyroidectomy

For papillary thyroid carcinoma, a total thyroidectomy is performed in the following situations:

  • tumor diameter > 1 cm
  • multifocal disease
  • infiltration of thyroid capsule
  • incidence of metastases
  • previously irradiated neck
  • familial accumulation of thyroid cancer
  • if the patient will be treated with radioactive iodine 

For follicular thyroid carcinoma, a total thyroidetomy is performed in the following situations:

  • infiltration of the thyroid capsule, especially in elderly
  • minimal invasive follicular thyroid carcinoma with diameter > 4 cm
  • follicular thyroid carcinoma with prominent invasive elements 
  • malignant Hürthle cell tumors (oxyphile)
  • if the patient will be treated with radioactive iodine 

For medullary thyroid carcinoma, a total thyroidectomy is performed.

For anaplastic thyroid carcinoma, a total thyroidectomy is performed secondary to radiation therapy if there is no metastasis.

Hemithyroidectomy

A hemithyroidectomy is usually performed when:  

  • there is a differentiated thyroid carcinoma tumor around 1 cm or less. That is, for low-risk patients.
  • the tumor has an ambiguous histology prior to surgery (mostly follicular neoplasia)
  • the patient is older with a shorter life expectancy
  • the patient is unable to take thyroid hormone replacement regularly

Goal

  • Cure the disease 
  • Palliative treatment

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