What is the role of surgery in the treatment of papillary thyroid carcinoma (PTC)?

Updated: Jun 18, 2020
  • Author: Ponnandai S Somasundar, MD, MPH, FACS; Chief Editor: Neetu Radhakrishnan, MD  more...
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Answer

Surgery is the definitive management of thyroid cancer. Various types of operations may be performed, ranging from lobectomy with isthmectomy to total thyroidectomy.

Lobectomy with isthmectomy is the minimal operation for a potentially malignant thyroid nodule. It is an option for patients younger than 40 years who have papillary thyroid carcinoma nodules that are smaller than 1 cm, well-defined, minimally invasive, and isolated. However, an important consideration in considering this approach is that approximately 10% of patients who have had only a lobectomy develop a recurrence in the contralateral lobe, and residual tissue has the potential to dedifferentiate to anaplastic cancer.

Subtotal thyroidectomy is a near-total thyroidectomy. The argument for this form of surgical intervention is that total thyroidectomy does not improve long-term prognosis, and subtotal thyroidectomy has a lower incidence of complications (eg, hypoparathyroidism, superior and/or recurrent laryngeal nerve injury) than total thyroidectomy.


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