Postoperative Radioiodine Therapy Research Articles

Clinical outcomes of low-dose and high-dose postoperative radioiodine therapy in patients with intermediate-risk differentiated thyroid cancer.

Recent studies have suggested that a low dose (LD) of radioiodine (RAI) is sufficient to treat differentiated thyroid cancer (DTC) even in patients with intermediate risk. However, these studies evaluated the efficacy of RAI therapy, irrespective of the results of the whole-body scan (WBS). The aim of the present study was to evaluate the response to LD and high-dose (HD) RAI therapy using two different criteria (with and without WBS results) and the reclassification system according to the revised 2015 guidelines of the American Thyroid Association in Korean intermediate-risk DTC patients. In addition, we evaluated the long-term clinical outcomes of treatment with LD and HD RAI. In total, 204 intermediate-risk DTC patients who underwent postoperative RAI therapy at two tertiary referral hospitals from 2003 to 2004 were enrolled in the present retrospective study. One hundred and twenty-four patients were treated with 3.7 and 5.55 GBq (HD) of RAI in one center and 80 patients were treated with 1.11 GBq (LD) in the other center. The success rate of RAI therapy was assessed with or without the inclusion of WBS results in the analysis. In addition, the response to therapy during the first 2 years of follow-up after the initial RAI therapy was categorized according to the reclassification system of 2015 American Thyroid Association guidelines as excellent response, indeterminate response, biochemical incomplete response, or structural incomplete response. Recurrence was defined as a newly detected cytologically or pathologically confirmed lesion. There were no significant differences between the success rates of the HD and LD groups irrespective of the inclusion of WBS results in the analysis (with WBS: 54.84 vs. 45.0%, P=0.23; without WBS: 60.48 vs. 62.5%, P=0.77). The response to HD and LD RAI therapy was excellent in 54.84 and 45.0% of the patients, respectively; indeterminate in 34.68 and 30.0% of the patients, respectively; biochemical incomplete in 4.03 and 13.75% of the patients, respectively; and structural incomplete in 6.45% and in 11.25% of the patients, respectively (P=0.04). In particular, the biochemical or structural incomplete response rate was lower in patients treated with HD than in patients treated with LD (HD, 10.48%; LD, 25.0%, P=0.01). At the last follow-up (HD, median 11 years; LD, median 10 years), patients who achieved an excellent response showed no evidence of disease. After the initial RAI therapy, eight patients in the HD group and 18 patients in the LD group who achieved either indeterminate response or biochemical incomplete response received additional RAI therapy. Seven patients (indeterminate response in five patients; biochemical incomplete response in two patients) in the HD group and seven patients (indeterminate response in five patients; biochemical incomplete response in two patients) in the LD group showed recurrences. LD RAI therapy after thyroidectomy appears to be insufficient in Korean DTC patients with intermediate risk. The patients in the LD group predominantly showed biochemical or structural incomplete response to initial RAI therapy and additional RAI therapy was required.

Ultrasound-Guided Percutaneous Laser Ablation of Unifocal Papillary Thyroid Microcarcinoma

Papillary thyroid microcarcinoma (PTMC) is usually associated with a favourable outcome. Management of PTMC varies from observation to total thyroidectomy and post-operative radioiodine therapy, but occasionally becomes a dilemma for patients who are unwilling to undergo surgery or are at high risk for surgery. Although the nature of PTMC is indolent, a few cases of local spread or distant metastases have also been reported in the long-term follow-up. Percutaneous laser ablation (PLA) is a minimally invasive technique that has been widely applied to benign thyroid nodules and demonstrated to be effective for reducing the volume of benign nodules. In our study, ultrasound-guided PLA was applied in treatment of unifocal PTMC. Conventional ultrasound and contrast enhanced ultrasound were used to evaluate the target lesion before and after PLA. Cytology and pathology were used to evaluate the efficacy of PLA. Short-term and long-term follow up was also performed after PLA. Ultrasound-guided PLA is an effective and safe method for treating unifocal PTMC.

Surgical Treatment of Large Neglected Tall-Cell Thyroid Papillary Cancer with Neck Skin Infiltration and Exulceration: A Case Report and Literature

Background: To present for the first time a clinical case of a patient with giant neglected and exulcerated tall-cell papillary thyroid cancer, who was surgically treated. Methods: We report a case of a 73-year-old woman with large firm infiltrated and exulcerated anterior neck tumefaction (12 cm in diameter) clinically suspected as anaplastic thyroid cancer. Patient had a goiter for more than 20 years with rapid growth in last months, after that presented with infiltration and exulceration of the skin. Results: Fine needle aspiration biopsy (FNAB) revealed papillary thyroid cancer (PTC). Total thyroidectomy with en-block dissection of the infrahyoid muscles and skin was performed. Lymph node metastasis were not present. Pathologically, goiter and tall-cell papillary carcinoma were present without anaplastic dedifferentiation. Postoperative radioiodine therapy was done, than L-thyroxin suppressive therapy, patient refused transcutaneous radiotherapy. Serum thyroglobulin was 0.15 ng/ml. Vocal cord paralysis and hypocalcaemia were not present. In following 3 years patient did not come to postoperative control, then she came with local recurrence of disease and tracheostomy. Tumor reduction was a second operation which was performed. Pathologically, it was tall-cell papillary carcinoma with regional lymph node metastases. The skin defect was reconstructed with a local transpositional flap. Patient refused radioiodine and transcutaneous radiotherapy and died 4 years after first operation, she was 77-years old. Conclusions: Skin infiltration and exulceration are rare in papillary thyroid cancer but they can be found in patients with neglected and poorly differentiated papillary carcinomas. Exulcerated tall cell papillary carcinoma can be unpredictable even in radically performed operation.

Long-Term Outcomes Following Therapy in Differentiated Thyroid Carcinoma: NTCTCS Registry Analysis 1987-2012.

Initial treatments for patients with differentiated thyroid cancer are supported primarily by single-institution, retrospective studies, with limited follow-up and low event rates. We report updated analyses of long-term outcomes after treatment in patients with differentiated thyroid cancer. The objective was to examine effects of initial therapies on outcomes. This was a prospective multi-institutional registry. A total of 4941 patients, median follow-up, 6 years, participated. Interventions included total/near-total thyroidectomy (T/NTT), postoperative radioiodine (RAI), and thyroid hormone suppression therapy (THST). Main outcome measures were overall survival (OS) and disease-free survival using product limit and proportional hazards analyses. Improved OS was noted in NTCTCS stage III patients who received RAI (risk ratio [RR], 0.66; P = .04) and stage IV patients who received both T/NTT and RAI (RR, 0.66 and 0.70; combined P = .049). In all stages, moderate THST (TSH maintained subnormal-normal) was associated with significantly improved OS (RR stages I-IV: 0.13, 0.09, 0.13, 0.33) and disease-free survival (RR stages I-III: 0.52, 0.40, 0.18); no additional survival benefit was achieved with more aggressive THST (TSH maintained undetectable-subnormal). This remained true, even when distant metastatic disease was diagnosed during follow-up. Lower initial stage and moderate THST were independent predictors of improved OS during follow-up years 1-3. We confirm previous findings that T/NTT followed by RAI is associated with benefit in high-risk patients, but not in low-risk patients. In contrast with earlier reports, moderate THST is associated with better outcomes across all stages, and aggressive THST may not be warranted even in patients diagnosed with distant metastatic disease during follow-up. Moderate THST continued at least 3 years after diagnosis may be indicated in high-risk patients.

Comparative results of treatment of children and adolescents with thyroid cancer at St. Petersburg Endocrine Surgery Centre and Mayo Clinic

Introduction. Thyroid cancer (TC) is the most often malignant tumor in childhood and made 1.5-3.0 % of all children population or 45.3 % of pediatric endocrine epithelial cancers. A lot of questions concerning to volume of thyroid surgery, postoperative radioiodine therapy needs to be discussed. Material and methods. During 1970-2011 in the Center (1 group) were operated 105 TC children and adolescent (up to 18 yeas) and in Mayo Clinic - 188 (2 group) in period 1940-2000. Since of 80-s in those clinics were used the same perioperative examinations, like TSH, T4, T3 blood levels, USG, fine needles aspiration biopsy, CT and morphological examinations. Results and discussion. Average age of the Center and Rochester patients was the same and achieve 16.3 ± 0.3 and 16.0 ± 0.5, accordingly. In both groups has prevailed girls: in the 1 group they made 73.3 % (M : F 1 : 2.7) and in the 2 - 70.7 % (M : F 1 : 2.4). Childhood differentiated TC were associated with aggressive behavior: regional metastases were found in 53.0 % and 81.4 %, extrathyroid TC spreading - in 9.6 and 19.7 %, distant metastases - in 9.6 and 4.8 %, accordingly. In our Center we have performed hemithyroidectomies and subtotal thyroidectomies in 58.1 % with ipsilateral central neck dissection (CND). In Mayo Clinic in all TC cases were performed thyroidectomy (TE) since 1950. TC relapses we have no observed in 1 group and they have place in 6.9 % 2 group patients, recurring lymphatic metastases - in 8.4 % and 20.7 %, accordingly. Radioiodine therapy (RIT) has performed in 21.1 % and 25.5 % operated children. In 1 group 95 (96.0 %) of 99 operated were alive during 5-36 years, in the 2 - only in two cases reason of death was TC, but in 14 - other malignant tumor. Conclusion. Childhood TC is associated with more locally aggressive and more frequent distant disease than its adult counterpart. Recurrence rates tend to be higher in children, but cause-specific mortality remains low. Optimal initial treatment of childhood TC should include TE and CND. RIT in childhood has increased possibility of others malignant tumor in follow up period.

The RET oncogene in papillary thyroid carcinoma.

Papillary thyroid carcinoma (PTC) is the most common form of thyroid cancer, accounting for greater than 80% of cases. Surgical resection, with or without postoperative radioiodine therapy, remains the standard of care for patients with PTC, and the prognosis is generally excellent with appropriate treatment. Despite this, significant numbers of patients will not respond to maximal surgical and medical therapy and ultimately will die from the disease. This mortality reflects an incomplete understanding of the oncogenic mechanisms that initiate, drive, and promote PTC. Nonetheless, significant insights into the pathologic subcellular events underlying PTC have been discovered over the last 2 decades, and this remains an area of significant research interest. Chromosomal rearrangements resulting in the expression of fusion proteins that involve the rearranged during transfection (RET) proto-oncogene were the first oncogenic events to be identified in PTC. Members of this fusion protein family (the RET/PTC family) appear to play an oncogenic role in approximately 20% of PTCs. Herein, the authors review the current understanding of the clinicopathologic role of RET/PTC fusion proteins in PTC development and progression and the molecular mechanisms by which RET/PTCs exert their oncogenic effects on the thyroid epithelium.

Children Thyroid Cancer treatment in Saint-Petersburg Endocrine SurgeryCenter and Mayo Clinic

Introduction Thyroid cancer (TC) is the most often malignant tumor in childhood and made 1.5 – 3.0% of all children population or 45.3% of pediatric endocrine epithelial cancers. A lot of questions concerning to volume of thyroid surgery, postoperative radio iodine therapy (RIT) needs to be discussed. Aim Estimation of childhood sporadic thyroid cancer specificity and comparison of children and adolescents treatment in Saint-Petersburg Endocrine Surgery Center (Russia) and Mayo Clinic (USA). Material and methods During 1970 –2011 in the Saint-Petersburg Center (1 group) were operated 105 TC children and adolescent (up to 20 yeas) and in Mayo Clinic – 188 (2 group) in 1940 – 2000 period. Since of 80-s in those clinics were used the same perioperative examinations, like TSH, T4, T3 blood levels, USG, fine needles aspiration biopsy, CT and morphological examinations. Results and discussion Average age of the Saint-Petersburg Center and Rochester patients was the same and achieve 16.3±0.3 and 16.0±0.5, accordingly. In both groups has prevailed girls: in the 1 group they made 73.3% (M:F 1:2.7) and in the 2 – 70.7% (M:F 1:2.4). Childhood differentiated TC were associated with aggressive behavior: regional metastases were found in 53.0% and 81.4%, extrathyroid TC spreading – in 9.6 and 19.7%, distant metastases - in 9.6 and 4.8%, accordingly. In our Center (1 group) we have performed hemithyroidectomies and subtotal Thyroidectomies in 58.1% with ipsilateral central neck dissection (CND). In Mayo Clinic in all TC cases were performed thyroidectomy (TE) since 1950. TC relapses we have no observed in 1 group and they have place in 6.9% 2 group patients, recurring lymphatic metastases – in 8.4% and 20.7%, accordingly. Radioiodine therapy (RIT) has performed in 21.1% and 25.5% operated children. In 1 group 95 (96.0 %) of 99 operated were alive during 5 – 36 years, in the 2– only in two cases reason of death was TC, but in 14 – other malignant tumor. Conclusion Childhood TC is associated with more locally aggressive and more frequent distant disease than its in adult coun­terpart. Recurrence rate stend to be higher in children, but cause-specific mortality remains low. Optimal initial treatment of childhood TC should include TE and CND. RIT in child hood has in creased possibility of others malignant tumor in follow up period.

Effects of Low-Dose and High-Dose Postoperative Radioiodine Therapy on the Clinical Outcome in Patients with Small Differentiated Thyroid Cancer Having Microscopic Extrathyroidal Extension

It is unclear whether differentiated thyroid cancer (DTC) patients classified as intermediate risk based on the presence of microscopic extrathyroidal extension (ETE) should be treated with low or high doses of radioiodine (RAI) after surgery. We evaluated success rates and long-term clinical outcomes of patients with DTC of small tumor size, microscopic ETE, and no cervical lymph node (LN) metastasis treated either with a low (1.1 GBq) or high RAI dose (5.5 GBq). This is a retrospective analysis of a historical cohort from 2000 to 2010 in a tertiary referral hospital. A total of 176 patients with small (≤2 cm) DTC, microscopic ETE, and no cervical LN metastasis were included. Ninety-six patients were treated with 1.1 GBq (LO group) and 80 patients with 5.5 GBq (HI group). Successful RAI therapy was defined as (i) negative stimulated thyroglobulin (Tg) in the absence of Tg antibodies, and (ii) absence of remnant thyroid tissue and of abnormal cervical LNs on ultrasonography. Clinical recurrence was defined as the reappearance of disease after ablation, which was confirmed by cytologically or pathologically proven malignant tissue or of distant metastatic lesions. There was no significant difference in the rate of successful RAI therapy between the LO and HI groups (p=0.75). In a subgroup analysis based on tumor size, success rates were not different between the LO group (34/35, 97%) and the HI group (50/56, 89%) in patients with a tumor size of 1-2 cm (p=0.24). In patients with smaller tumor size (≤1 cm), there was no significant difference in success rates between the LO (59/61, 97%) and HI groups (22/24, 92%; p=0.30). No patient had clinical recurrences in either group during the median 7.2 years of follow-up. Low-dose RAI therapy is sufficient to treat DTC patients classified as intermediate risk just by the presence of microscopic ETE.

PP138: Effects of pilocarpine on salivary gland function after postoperative radioiodine therapy for differntiated thyroid cancer

Purpose The aim of this study was to investigate the effect of pilocarpine on salivary gland function in patients with postoperative 131I therapy-induced salivary dysfunction using a visual analog symptom scale and quantitative analysis of salivary flow rate, as well as salivary gland scintigraphy. Materials and methods Fifty patients who had RI-induced salivary dysfunction (sialadenitis, xerostomia, or hypogeusia) after treatment of 131I for postoperative ablation of differentiated thyroid cancer were enrolled. 25 patients were assigned randomly to the pilocarpine treatment group, which received 5 mg pilocarpine tid in addition to traditional conservative treatment such as hydration, sucking on sour candies or lemons, and massaging the affected gland, and 25 patients were assigned to the control group with only conservative treatment. Salivary dysfunction was graded according to a visual analog symptom scale before and 3 month after treatment. Salivary flow rate was measured and quantitative salivary gland scintigraphy was performed for analysis of salivary parenchymal function. Results There were no statistical differences in the mean age and the mean dose of 131I administered between two groups. The salivary symptom scale on sialadenitis was significantly improved in the treatment group compared to the control group. But pilocarpine treated group showed no significant improvement of the function parameter by salivary flow rate as well as quantitative salivary scintigraphy compared to the control group. Conclusions Pilocarpine treatment reduced the occurrence of symptoms on salivary dysfunction. Salivary flow rate and scintigraphic parameters were not statistically different between the pilocarpine treated and control group, which suggest that adding pilocarpine to traditional sialogogues may not improve the parenchymal damage to salivary gland.

Meta-Analysis of Squamous Cell Carcinoma of Thyroid

Received February 22, 2013 Revised May 18, 2013 Accepted May 22, 2013 Address for correspondence Seung Hoon Woo, MD Department of Otorhinolaryngology, Gyeongsang National University, 79 Gangnam-ro, Jinju 660-702, Korea Tel +82-55-750-8173 Fax +82-55-759-0613 E-mail lesaby@hanmail.net Background and ObjectivesZZPrimary squamous cell carcinoma (SCC) of thyroid is an unusual tumor, accounted for approximately 1.1% of all neoplasms of the thyroid gland. It is highly lethal, like anaplastic thyroid carcinoma, in terms of aggressive clinical behavior. In the literature, the best treatment of this tumor is by surgery and the use of combination therapy that includes postoperative radiation, chemotherapy and radioiodine therapy; however, the effect of treatment is very poor. This study aims to identify the clinical features of SCC of thyroid, and to devise a better treatment method. Subjects and MethodZZJournals citing SCC of thyroid were identified from Pubmed, Korea Med, and Google and the clinical records reported therewithin from 1990 to 2013 were reviewed. A total of 40 patients were analyzed from 21 well-organized papers by searching the following keywords: squamous cell carcinoma, primary, thyroid, excerpt of the patient’s age, sex, clinical features, pathologic findings, therapy, course and prognosis. ResultsZZWe analyzed the treatment results of 40 patients from a total of 21 papers. Patients, consisting of 17 men and 23 women, were found in the age range of 24-88, with the mean age of 63.2. The follow-up period ranged from one to 96 months, with the mean being 15 months, and the size of the mass varied from 1 cm to 15 cm. Histopathologically, we found 13 patients with only SCC mixture of SCC and 22 patients with papillary thyroid carcinoma (PTC). Each of the following diseases were identified with one patient: a mixture of SCC and Hashimoto thyroiditis, a mixture of follicular thyroid carcinoma (FTC), SCC and FTC and mixed Hurtle cell cancer, SCC and PTC and mixed Hashimoto thyroiditis, and SCC, PTC with mixed insula cancer. Thirty-two patients underwent total thyroidectomy, and 30 patients underwent total thyroidectomy accompanied by neck dissection. Twelve patients received postoperative radiation therapy, and five patients received postoperative chemotherapy. Nineteen patients were observed without recurrence of the disease, and ten patients were found to be in stage III or less. ConclusionZZSCC of the thyroid showed aggressive clinical characteristics, however, good results can be expected with early diagnosis and treatment. If tumor is found only within the thyroid, we expect good therapeutic results after the same treatment as PTC. Korean J Otorhinolaryngol-Head Neck Surg 2013;56:425-30

Thyroglossal Duct Carcinoma: A Case Series and Approach to Management

ABSTRACT Thyroglossal duct carcinoma (TGDC) is a rare disease with few reported series. No clear consensus exists regarding further management after adequate excision of the cyst, especially the role of total thyroidectomy and postoperative radioiodine therapy. We review our experience of nine cases and the literature to clarify the management of this rare condition. A retrospective study over a period of 10 years was performed using the clinical records from Christian Medical College, Vellore to identify patients with TGDC and to assess the frequency of cases with concomitant papillary carcinoma of the thyroid. The clinical presentation, fine needle aspiration cytology (FNAC), imaging, treatment and follow-up were analyzed. There were a total of nine cases of TGDC with five males. Imaging available in six patients detected a suspicious lesion in four cysts and three thyroid glands. Preoperative FNAC detected atypical cells in two of five cases. Thyroid carcinoma was seen in four (44.4%) after histopathological evaluation. Ultrasound of the neck and image-guided FNAC of the cyst may be adequate initial investigation for thyroglossal cysts. FNAC by itself is not a good investigation to diagnose TGDC as rate of false-negatives and inadequate specimens were high. Solid components and calcification on imaging were predictive of carcinoma within a thyroglossal cyst in 100% cases. All patients with TGDC may be offered total thyroidectomy as a simultaneous or staged procedure to address the high incidence of concomitant thyroid foci of cancer. The role of adjuvant therapy is still debatable.

Outcome After High-Dose Radioiodine Therapy for Advanced Differentiated Thyroid Carcinoma in Childhood

Objective. To evaluate the clinical outcome in childhood patients receiving postoperative high-dose radioiodine therapy for advanced differentiated thyroid carcinoma. Method. Patients under 18 years old with neck diseases (n = 4) or distant metastases (n = 10) received postoperative radioiodine ablation and repeated treatments for a median of 2 (0.8˜10) years with an averaged activity of 25.0 (7.0˜72.2) GBq. Results. Partial remission was achieved in 6, stable disease in 6 and progressive disease in 2 patients, without severe side effects except for two Grade 1 and one Grade 2 WHO haematological toxicity. The median survival time from diagnosis to the last treatment sessions was 5.3 (range, 0.7˜14.5) years. Conclusion. High-dose radioiodine treatment was well tolerated with satisfactory outcome in childhood patients with advanced differentiated thyroid carcinoma.

1418 POSTER Post-operative radioiodine therapy in children – an effective tool for decreasing locoregional recurrence and treatment of distant metastases in differentiated thyroid cancer

1418 POSTER Post-operative radioiodine therapy in children – an effective tool for decreasing locoregional recurrence and treatment of distant metastases in differentiated thyroid cancer

Basedow-Struma mit papillärem Schilddrüsenkarzinom - Zufall oder Zusammenhang?

A 41-year-old woman presented with hyperhydrosis, tremor, restlessness, sleeplessness and diarrhea. She had a tachycardia and later she developed soreness of her conjunctives. A tender goitre could be palpated. Laboratory results showed thryeotoxicosis and later elevated TRAK. Ultrasound revealed a thyroid nodule. Scintigraphic uptake was generally elevated. Graves disease was diagnosed. After 12 months of thyreostatic medication recurrence occurred and a thyroidectomy was performed. Histologically a papillary cancer was found and postoperative radioiodinetherapy was added. Due to leading symptoms of thyreotoxicosis the thyroid nodule has preoperatively not been paid enough attention to. A pathophysiologic association of Graves disease and differentiated thyroid cancer is controversely discussed but seems possible considering present literature data. Scintigraphically "cold" nodules in graves disease, as in simple nodular goitre, have a higher probability of malignancy.

Insular Thyroid Carcinoma: Collective Analysis of Clinicohistologic Prognostic Factors and Treatment Effect with Radioiodine or Radiation Therapy

Insular thyroid carcinoma is a distinctive clinicopathologic entity with aggressive behavior and frequent lethal disease. But because it is rare, no single institute has sufficient experience with the clinicopathologic features and treatment effect of radioiodine. A literature review and collective analysis might facilitate patient management. From January 1991 to December 2005, 9 patients with insular thyroid carcinoma were diagnosed in Taipei Veterans General Hospital. Clinicopathologic data were collected for analysis. The English literature about insular carcinoma was searched in Medline. Patients with detailed descriptions of treatment and followup were enrolled. Clinicopathologic features, rate of lymph node and distant metastasis, and prognostic factors were analyzed. Seventy-three of 486 patients collected from 23 articles with detailed description of treatment and followup were combined with our 9 patients for analysis, making a total of 82 patients in this article. The mean period of patient followup was 84.5 months. There were 26 (31.7%) men and 56 (68.3%) women. The rate of lymph node metastasis was 49%, and distant metastasis was 57.5%. Disease-specific death rate was 37.8%. The 5- and 10-year survival rates of insular carcinoma were 72.2% and 52%, respectively. Patient age older than 45 years (p=0.0004) and distant metastasis (p<0.0001) were poor prognostic factors. Use of radioiodine therapy (p=0.9789) and radiation therapy (p=0.2172) were not associated with prolonged survival. Patients with insular thyroid carcinoma have unfavorable outcomes. Postoperative radioiodine therapy or radiotherapy seemed not to be strongly associated with prolonged survival.

Moderne Schilddrüsenchirurgie - individuelle operative Verfahrenswahl in Abhängigkeit von der Grunderkrankung und Funktionsstörung

Ziel der modernen Schilddrüsenchirurgie ist eine morphologie- und funktionsgerechte morbiditätsarme Schilddrüsenresektion. Vor allem bei gutartigen Schilddrüsenerkrankungen ist die dauerhafte Beseitigung der mechanischen oder funktionellen Störung oberstes Behandlungsziel. Hierbei ist das Ausmaß der Schilddrüsenresektion abhängig von der Art der Schilddrüsengrunderkrankung und dem Ausmaß pathologisch veränderten Schilddrüsengewebes. Intraoperativ sollte routinemäßig der N. laryngeus recurrens in seinem Verlauf und möglichst viele Nebenschilddrüsen zur postoperativen Morbiditätsminimierung identifiziert werden. Die chirurgische Therapie der verschiedenen Schilddrüsenkarzinome berücksichtigt heute die erheblich tumorbiologische Varianz mit entsprechend unterschiedlichem Metastasierungspotenzial und Langzeitprognose. Regeleingriff beim differenzierten Schilddrüsenkarzinom (papillär, follikulär) ist die totale Thyreoidektomie mit zervikozentraler systematischer Lymphadenektomie mit anschließender Radioiodtherapie. Hierbei sollte die systematische Lymphadenektomie im Falle von zervikolateral befallenen Lymphknoten auf die befallenen Kompartimente schon bei dem Primäreingriff ausgedehnt werden. Für das medulläre Schilddrüsenkarzinom stellt die vollständige Tumorresektion auch heute noch die einzige kurative Therapieoption dar. Hier sollte als Regeleingriff bei klinischen manifestem medullären Schilddrüsenkarzinom die totale Thyreoidektomie mit vollständiger systematischer zervikozentraler und zervikolateraler Lymphadenektomie durchgeführt werden. Zusätzlich sollte immer durch eine Genuntersuchung eine erbliche Torerkrankung ausgeschlossen werden. Aufgrund der extrem schlechten Prognose beim anaplastischen Schilddrüsenkarzinom sollte eine palliative Thyreoidektomie nur in den Fällen durchgeführt werden, in denen keine andere Möglichkeit besteht, die Luftwege zu sichern.

Thyroidectomy and lymphadenectomy

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.