Thyroidectomy and lymphadenectomy

Abstract

In benign goiter, thyroidectomy is only indicated in patients with nodular alterations of the complete thyroid gland. There is no evidence indicating that total thyroidectomy could improve the postoperative results in patients with Graves' disease. In Germany, thyroidectomy with cervicocentral lymph node dissection is the standard procedure for all differentiated thyroid carcinomas. However, there are no data to prove that this approach is superior to less radical procedures. Avoidance of reoperations and optimal conditions for effective postoperative radioiodine therapy are arguments for this aggressive strategy. In patients with medullary carcinoma or with detected ret-proto-oncogene mutations, thyroidectomy with cervicocentral lymphadenectomy should be the initial operation. The cervicolateral and mediastinal compartments should be dissected when clinically obvious lymph node metastases are present in patients with differentiated carcinomas. In patients with medullary carcinomas, persistently increased calcitonin levels after the initial operation are sufficient indication for this procedure. Thyroidectomy is an important part of the multimodal approach in patients with anaplastic carcinomas. The operative technique of thyroidectomy is presented as well as the technique of cervical lymphadenectomy in consideration of the lymphatic drainage of the thyroid gland.