Thyroidectomy For Differentiated Thyroid Carcinoma Research Articles

Prophylactic lymph node dissection in clinically N0 differentiated thyroid carcinoma: example of personalized treatment.

Considering the 'differentiated thyroid carcinoma (DTC) epidemic', the indolent nature of DTC imposes a treatment paradigm shift toward elimination of recurrence. Lymph node metastases in cervical compartments, encountered in 20-90% of DTC, are the main culprit of recurrent disease, affecting 5-30% of patients. Personalized risk-stratified cervical prophylactic lymph node dissection (PLND) at initial thyroidectomy in DTC with no clinical, sonographic or intraoperative evidence of lymph node metastases (clinically N0) has been advocated, though not unanimously. The present review dissects the controversy over PLND. Weighing the benefit yielded from PLND up against the PLND-related morbidity is so far hampered by the inconsistent profit yielded by PLND and the challenging patient selection. Advances in tailoring PLND are anticipated to empower optimal patient care.

Factors Influencing the Presence of Remnant Thyroid Tissue After Thyroidectomy for Differentiated Thyroid Carcinoma

Differentiated thyroid carcinoma (DTC) is the most common endocrine malignancy. The study was performed to evaluate the factors that are likely to be responsible for the presence of remnant thyroid tissue. The data of 183 patients who underwent total thyroidectomy for DTC were retrospectively reviewed. The remnant thyroid tissue was determined by technetium-99 m pertechnetate (Tc-99 m) scintigraphy. The association of all possible factors (age, gender, size, multifocality, type, and characteristics of the tumor), extension of thyroidectomy, postoperative serum thyroglobulin (Tg), Tg antibody, and thyroid stimulating hormone levels with the presence of remnant tissue was evaluated. Remnant thyroid tissue was more common in patients with intermediate or high-risk features compared to low-risk group (p < 0.001) and in patients who underwent total thyroidectomy compared to patients with total thyroidectomy and central lymph node dissection (p = 0.009). Age, gender, and size, multifocality, type, and characteristics of the tumor were not found to be associated with the presence of remnant tissue. The extent of surgery is the single independent factor for the presence of remnant thyroid tissue after thyroidectomy (p < 0.001). The patients with intermediate and high-risk and extensive surgery were more likely to have remnant thyroid tissue after thyroidectomy for DTC.