What is the role of surgery in the treatment of follicular thyroid carcinoma (FTC)?

Updated: Jun 18, 2020
  • Author: Luigi Santacroce, MD; Chief Editor: Neetu Radhakrishnan, MD  more...
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Answer

Surgery is the definitive management of thyroid cancer, and various types of operations may be performed. 

In a study by Asari et al of 207 patients with FTC, the 127 patients with minimally invasive growth had no lymph node metastases. According to the authors, total thyroidectomy is recommended for all patients with FTC, but patients with widely invasive FTC need more aggressive surgery because of a higher tendency toward lymph node metastases. Patients with minimally invasive disease have an excellent prognosis with a limited need for nodal surgery, according to this study. [26]

In a study by Spinelli et al of pediatric patients with FTC (age 18 years and younger), total thyroidectomy was performed in 9 of the 30 patients; 21 initially underwent hemithyroidectomy, but 11 of those subsequently required completion of thyroidectomy. [27]  The authors conclude that a conservative approach to surgery seems valid for pediatric patients diagnosed with minimally invasive FTC; they recommend completion of thyroidectomy for patients with wide vascular invasion and/or a tumor > 4 cm, especially with a high postoperative thyroglobulin level, and advise that total thyroidectomy followed by radioiodine therapy is generally indicated for patients with one or more of the following:

  • Multifocal neoplasia
  • Tumor size ≥4 cm
  • Extrathyroid extension
  • Lymph node metastasis
  • Distant metastasis

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