The extent of thyroidectomy for differentiated thyroid cancer.
Scenario 1: Removal of only one lobe of the gland requires the following 5 conditions to be met simultaneously.
(1) No history of radiation to the neck
(2) No distant metastasis
(3) No extra-thyroidal invasion
(4) mass less than 1 cm in diameter
(5) No other adverse pathological types.
Situation 2: Bilateral total or sub-total thyroid excision, satisfying any of the following is sufficient.
(1) history of radiation to the neck
(2) distant metastases
(3) Bilateral cancer nodules
(4) Extrathyroidal invasion
(5) mass larger than 4 cm in diameter
(6) Poor pathological type
(7) Bilateral multiple lymph node metastases in the neck.
In most patients, the mass is already more than 1 cm in diameter at the time of consultation, so it does not meet the criteria of “Case 1”. However, surgical treatment is individual and specific, and patients need to talk to their doctors about the specific surgical procedure. It is also important to know that it is extremely important to have a standardized first surgery. In order to avoid subjective errors in the judgment of a single surgeon, patients in the United States often consult with several surgeons (second opinion).
The advantages of total bilateral thyroidectomy are as follows.
1. the incidence of contralateral thyroid cancer is reduced.
2. Only with total excision can blood (Tg) be checked to monitor for recurrence.
3. It is a prerequisite for post-surgical iodine 131 therapy to eliminate distant metastatic lesions.
Advantages of unilateral thyroidectomy.
The risk of surgery is relatively small.