The Extent of Thyroidectomy in Differentiated Thyroid Cancers- Revisited with Evidence

Abstract

Differentiated thyroid cancer has become increasingly prevalent in clinical practice. Papillary and follicular thyroid carcinoma are mainly included in this category. They are generally slow growing, and their prognosis is usually excellent. Contemporary management of differentiated thyroid cancer requires a multidisciplinary approach. The initial treatment is surgery. The current guideline focuses on risk stratification of patients with papillary thyroid cancer to guide the treatment strategy. Hence, the choice of initial operative treatment relies much on the tumor size. Thyroid lobectomy is preferred for small tumors less than one cm in size, unifocal, intrathyroidal papillary thyroid carcinoma without aggressive risk features. Total thyroidectomy is offered to patients for extrathyroidal extension, multifocal disease, aggressive risk features, size more than 4 cm, lymph node metastasis, distant metastasis, family history of thyroid cancer or genetic syndromes or childhood radiation.