SURGICAL MANAGEMENT OF DIFFERENTIATED THYROID CARCINOMA

Abstract

Controversy exists about optimal surgical treatment of differentiated thyroid carcinoma. The main point of the argument centers on the type or the extent of thyroidectomy. The purpose of this clinical retrospective study is to review the outcomes of surgical procedures carried out on patients with differentiated carcinoma of the thyroid. We conducted a retrospective analysis of 68 patients with differentiated thyroid carcinoma who underwent surgery between 1990 and 2000. Patients (11 men and 57 women)ranged in age from 17 to 83 years (mean 44 years). When decision making regarding the extent of thyroidectomy and servical node dissection, we took into consideration gross findings at operation and prognostic factors such as patients age, tumor size, presence of local invasion, presence of nodal involvement and distant metastases. The most common presenting symptom was cervical mass (87%). Fine needle aspiration biopsy (FNAB) was employed in 57 patients and was diagnostic for malignancy in 41 patients (72%). Histologic examination revealed 61 cases of papiller carcinoma and 7 cases of follicular carcinoma. At the time of diagnosis, 19 patients had cervical enlarged lymph nodes and 25 patients had local invasion. Surgical approaches consisted of total thyroidectomy in 49 patients (72%), lobectomy and subtotal lobectomy in 17 (25%), lobectomy and near-total lobectomy in 2 (3%). Modified neck dissection was added to eleven patients who underwent total thyroidectomy. There was no operative death but cancer related mortality rate was 10.3%. Temporary and permanent hypoparathyroidizm rate were 22% and 4%. Rates of temporary and permanent recurrent laryngeal nerve palsy were 4% and 1% respectively. We concluded that the selection of treatment for differentiated thyroid carcinoma should be considered on the basis of risk factors. Lobectomy plus subtotal lobectomy, near total thyroidectomy and total thyroidectomy with or without cervical node dissection are all safe procedures to be performed with minimal morbidity.