Lobectomy Versus Total Thyroidectomy for Follicular Microcarcinomas

  • Linwah YipEmail author
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)


The diagnosis of follicular thyroid cancer <1 cm is most likely to occur after initial thyroid lobectomy. High risk features include widely invasive, extensive angioinvasion (≥4 foci), or presence of distant metastasis and are the primary predictors of poor prognosis. In the absence of these features, thyroid lobectomy is likely adequate for treatment.


Follicular thyroid carcinoma Microcarcinoma Extent of thyroidectomy Thyroid surgery Thyroid cancer 


  1. 1.
    Hundahl SA, Fleming ID, Fremgen AM, Menck HR. A National Cancer Data Base report on 53,856 cases of thyroid carcinoma treated in the U.S., 1985-1995 [see comments]. Cancer. 1998;83(12):2638–48. PMID: 9874472.CrossRefPubMedGoogle Scholar
  2. 2.
    Franc B, de la Salmoniere P, Lange F, Hoang C, Louvel A, de Roquancourt A, et al. Interobserver and intraobserver reproducibility in the histopathology of follicular thyroid carcinoma. Hum Pathol. 2003;34(11):1092–100. PMID: 14652809.CrossRefPubMedGoogle Scholar
  3. 3.
    Aschebrook-Kilfoy B, Grogan RH, Ward MH, Kaplan E, Devesa SS. Follicular thyroid cancer incidence patterns in the United States, 1980–2009. Thyroid. 2013;23(8):1015–21. PMID: 23360496. PMCID: 3752506.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Aschebrook-Kilfoy B, Ward MH, Sabra MM, Devesa SS. Thyroid cancer incidence patterns in the United States by histologic type, 1992–2006. Thyroid. 2011;21(2):125–34. PMID: 21186939. PMCID: 3025182.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Brito JP, Al Nofal A, Montori VM, Hay ID, Morris JC. The impact of subclinical disease and mechanism of detection on the rise in thyroid cancer incidence: a population-based study in Olmsted County, Minnesota during 1935 through 2012. Thyroid. 2015;25(9):999–1007. PMID: 26103159. PMCID: 4560845.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    LiVolsi VA, Baloch ZW. Follicular-patterned tumors of the thyroid: the battle of benign vs. malignant vs. so-called uncertain. Endocr Pathol. 2011;22(4):184–9. PMID: 22072271.CrossRefPubMedGoogle Scholar
  7. 7.
    Cipriani NA, Nagar S, Kaplan SP, White MG, Antic T, Sadow PM, et al. Follicular thyroid carcinoma: how have histologic diagnoses changed in the last half-century and what are the prognostic implications? Thyroid. 2015;25(11):1209–16. PMID: 26440366. PMCID: 4948203.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Liu J, Singh B, Tallini G, Carlson DL, Katabi N, Shaha A, et al. Follicular variant of papillary thyroid carcinoma: a clinicopathologic study of a problematic entity. Cancer. 2006;107(6):1255–64. PMID: 16900519.CrossRefPubMedGoogle Scholar
  9. 9.
    Lloyd RV, Erickson LA, Casey MB, Lam KY, Lohse CM, Asa SL, et al. Observer variation in the diagnosis of follicular variant of papillary thyroid carcinoma. Am J Surg Pathol. 2004;28(10):1336–40. PMID: 15371949.CrossRefPubMedGoogle Scholar
  10. 10.
    Cibas ES, Ali SZ. The Bethesda system for reporting thyroid cytopathology. Thyroid. 2009;19(11):1159–65. PMID: 19888858.CrossRefPubMedGoogle Scholar
  11. 11.
    Sillery JC, Reading CC, Charboneau JW, Henrichsen TL, Hay ID, Mandrekar JN. Thyroid follicular carcinoma: sonographic features of 50 cases. AJR Am J Roentgenol. 2010;194(1):44–54. PMID: 20028904.CrossRefPubMedGoogle Scholar
  12. 12.
    Haugen BRM, Alexander EK, Bible KC, Doherty G, Mandel SJ, Nikiforov YE, et al. American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2015. PMID: 26462967.Google Scholar
  13. 13.
    DeLellis R, Lloyd RV, Heitz PU, Eng C. WHO/IARC classification of tumours. 3rd ed. Lyon: IARC Press; 2004.Google Scholar
  14. 14.
    D’Avanzo A, Treseler P, Ituarte PH, Wong M, Streja L, Greenspan FS, et al. Follicular thyroid carcinoma: histology and prognosis. Cancer. 2004;100(6):1123–9. PMID: 15022277.CrossRefPubMedGoogle Scholar
  15. 15.
    O’Neill CJ, Vaughan L, Learoyd DL, Sidhu SB, Delbridge LW, Sywak MS. Management of follicular thyroid carcinoma should be individualised based on degree of capsular and vascular invasion. Eur J Surg Oncol. 2011;37(2):181–5. PMID: 21144693.CrossRefPubMedGoogle Scholar
  16. 16.
    Lee YM, Lee YH, Song DE, Kim WB, Sung TY, Yoon JH, et al. Prognostic impact of further treatments on distant metastasis in patients with minimally invasive follicular thyroid carcinoma: verification using inverse probability of treatment weighting. World J Surg. 2017;41(4):1144. PMID: 28101608.CrossRefPubMedGoogle Scholar
  17. 17.
    Kim HJ, Sung JY, Oh YL, Kim JH, Son YI, Min YK, et al. Association of vascular invasion with increased mortality in patients with minimally invasive follicular thyroid carcinoma but not widely invasive follicular thyroid carcinoma. Head Neck. 2014;36(12):1695–700. PMID: 24115217.CrossRefPubMedGoogle Scholar
  18. 18.
    Ito Y, Hirokawa M, Masuoka H, Yabuta T, Kihara M, Higashiyama T, et al. Prognostic factors of minimally invasive follicular thyroid carcinoma: extensive vascular invasion significantly affects patient prognosis. Endocr J. 2013;60(5):637–42. PMID: 23327839.CrossRefPubMedGoogle Scholar
  19. 19.
    Sugino K, Ito K, Nagahama M, Kitagawa W, Shibuya H, Ohkuwa K, et al. Prognosis and prognostic factors for distant metastases and tumor mortality in follicular thyroid carcinoma. Thyroid. 2011;21(7):751–7. PMID: 21615311.CrossRefPubMedGoogle Scholar
  20. 20.
    Podda M, Saba A, Porru F, Reccia I, Pisanu A. Follicular thyroid carcinoma: differences in clinical relevance between minimally invasive and widely invasive tumors. World J Surg Oncol. 2015;13:193. PMID: 26041024. PMCID: 4458056.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Lo CY, Chan WF, Lam KY, Wan KY. Follicular thyroid carcinoma: the role of histology and staging systems in predicting survival. Ann Surg. 2005;242(5):708–15. PMID: 16244545. PMCID: 1409851.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    D’Avanzo A, Ituarte P, Treseler P, Kebebew E, Wu J, Wong M, et al. Prognostic scoring systems in patients with follicular thyroid cancer: a comparison of different staging systems in predicting the patient outcome. Thyroid. 2004;14(6):453–8. PMID: 15242573.CrossRefPubMedGoogle Scholar
  23. 23.
    Lang BH, Lo CY, Chan WF, Lam KY, Wan KY. Prognostic factors in papillary and follicular thyroid carcinoma: their implications for cancer staging. Ann Surg Oncol. 2007;14(2):730–8. PMID: 17103065.CrossRefPubMedGoogle Scholar
  24. 24.
    Sugino K, Kameyama K, Ito K, Nagahama M, Kitagawa W, Shibuya H, et al. Outcomes and prognostic factors of 251 patients with minimally invasive follicular thyroid carcinoma. Thyroid. 2012;22(8):798–804. PMID: 22853727.CrossRefPubMedGoogle Scholar
  25. 25.
    Lee YM, Song DE, Kim TY, Sung TY, Yoon JH, Chung KW, et al. Risk factors for distant metastasis in patients with minimally invasive follicular thyroid carcinoma. PLoS One. 2016;11(5):e0155489. PMID: 27171147. PMCID: 4865049.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Asari R, Koperek O, Scheuba C, Riss P, Kaserer K, Hoffmann M, et al. Follicular thyroid carcinoma in an iodine-replete endemic goiter region: a prospectively collected, retrospectively analyzed clinical trial. Ann Surg. 2009;249(6):1023–31. PMID: 19474675.CrossRefPubMedGoogle Scholar
  27. 27.
    Ito Y, Hirokawa M, Higashiyama T, Takamura Y, Miya A, Kobayashi K, et al. Prognosis and prognostic factors of follicular carcinoma in Japan: importance of postoperative pathological examination. World J Surg. 2007;31(7):1417–24. PMID: 17534542.CrossRefPubMedGoogle Scholar
  28. 28.
    Machens A, Holzhausen HJ, Dralle H. The prognostic value of primary tumor size in papillary and follicular thyroid carcinoma. Cancer. 2005;103(11):2269–73. PMID: 15856429.CrossRefPubMedGoogle Scholar
  29. 29.
    Kuo EJ, Roman SA, Sosa JA. Patients with follicular and Hurthle cell microcarcinomas have compromised survival: a population level study of 22,738 patients. Surgery. 2013;154(6):1246–53. discussion 53-4. PMID: 23993409.CrossRefPubMedGoogle Scholar
  30. 30.
    Melo M, da Rocha AG, Vinagre J, Batista R, Peixoto J, Tavares C, et al. TERT promoter mutations are a major indicator of poor outcome in differentiated thyroid carcinomas. J Clin Endocrinol Metab. 2014;99(5):E754–65. PMID: 24476079. PMCID: 4191548.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Dionigi G, Kraimps JL, Schmid KW, Hermann M, Sheu-Grabellus SY, De Wailly P, et al. Minimally invasive follicular thyroid cancer (MIFTC)--a consensus report of the European Society of Endocrine Surgeons (ESES). Langenbecks Arch Surg. 2014;399(2):165–84. PMID: 24233345.CrossRefPubMedGoogle Scholar
  32. 32.
    Sugino K, Kameyama K, Nagahama M, Kitagawa W, Shibuya H, Ohkuwa K, et al. Does completion thyroidectomy improve the outcome of patients with minimally invasive follicular carcinoma of the thyroid? Ann Surg Oncol. 2014;21(9):2981–6. PMID: 24770681.CrossRefPubMedGoogle Scholar
  33. 33.
    Goffredo P, Cheung K, Roman SA, Sosa JA. Can minimally invasive follicular thyroid cancer be approached as a benign lesion?: a population-level analysis of survival among 1,200 patients. Ann Surg Oncol. 2013;20(3):767–72. PMID: 23111705.CrossRefPubMedGoogle Scholar
  34. 34.
    Megwalu UC, Green RW. Total thyroidectomy versus lobectomy for the treatment of follicular thyroid microcarcinoma. Anticancer Res. 2016;36(6):2899–902. PMID: 27272803.PubMedGoogle Scholar
  35. 35.
    Aschebrook-Kilfoy B, James B, Nagar S, Kaplan S, Seng V, Ahsan H, et al. Risk factors for decreased quality of life in thyroid cancer survivors: initial findings from the North American thyroid cancer survivorship study. Thyroid. 2015;25(12):1313–21. PMID: 26431811. PMCID: 4684649.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Applewhite MK, James BC, Kaplan SP, Angelos P, Kaplan EL, Grogan RH, et al. Quality of life in thyroid cancer is similar to that of other cancers with worse survival. World J Surg. 2016;40(3):551–61. PMID: 26546191.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Endocrine Surgery, Department of SurgeryUniversity of Pittsburgh School of MedicinePittsburghUSA

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