Treatment and Management

A partial thyroidectomy is recommended only for low-risk patients with unifocal, intralobar, and papillary thyroid tumours smaller than 1.5 cm in diameter. There are strong proponents of near-total or total thyroidectomy, although the extent of thyroid surgery remains controversial. Near-total or total thyroidectomy is associated with a lower recurrence rate; however, it may increase the risk of surgical complications. ^{[1], [2], [3]} Furthermore, total removal of the thyroid gland makes WBS and Tg tests easier to interpret throughout the patient’s follow-up.

Radioiodine therapy allows for the treatment of metastatic disease along with ablation of any residual thyroid tissue to prevent recurrence. Additionally, radioiodine therapy can ablate local recurrences that cannot be removed surgically. Postoperative radioiodine therapy can decrease recurrence and death rates. However, in certain low-risk patients, radioiodine therapy can be avoided. ^{[1], [2], [3]}

Long-term management with thyroid hormone suppression therapy (THST) has demonstrated a beneficial effect on survival and recurrence.

References

1. Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med. 1998;338:297-306.

2. Pacini F, Lari R, Masseo S, et al. Diagnostic value of a single serum thyroglobulin determi-nation on and off thyroid suppressive therapy in the follow-up of patients with differentiated thyroid cancer. Clinical Endocrinology. 1985;23:405-411.

3. Fuchshuber P, Loree TR, DeLacure MD, et al. Differentiated thyroid carcinoma: risk group assignment and management controversies. Oncology. 1998;12:99-106.