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Lobectomy Versus Total Thyroidectomy in Suspicious or Malignant Thyroid Nodules

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Transoral Neck Surgery

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Abstract

Differentiated thyroid cancer frequently has an excellent prognosis, with very low risk of recurrence after adequate surgery. A growing body of evidence demonstrates no benefit from radioactive iodine or extensive surgery in these low-risk patients and suggests that many individuals will be well treated with less than total thyroidectomy. Determining the best initial surgery to minimize complications but also avoid reoperation is a critical goal of the preoperative assessment. Accurate assessment is particularly valuable with transoral surgery, where conversion to open procedures for unexpected intraoperative findings and reoperation both present challenges. Ultrasound findings and patient characteristics are variably helpful in predicting postoperative risk status. The development of strategies to determine the best surgical approach in individual patients has been a main focus of the American Thyroid Association guidelines, which now recommend lobectomy be considered for solitary nodules up to 4 cm without evidence of extrathyroidal extension on ultrasound. The cost-effectiveness of this or other paradigms for predicting risk remains an active area of research.

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Authors and Affiliations

  1. Division of Endocrinology, Diabetes and Metabolism, The Johns Hopkins School of Medicine, Baltimore, MD, USA

    Jennifer S. Mammen & David S. Cooper

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  1. Jennifer S. Mammen
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  2. David S. Cooper
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Correspondence to Jennifer S. Mammen .

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Editors and Affiliations

  1. Otolaryngology – Head and Neck Surgery, Johns Hopkins Medicine Otolaryngology – Head and Neck Surgery, Baltimore, MD, USA

    Jonathon O. Russell

  2. Department of Surgery, University of Kentucky, Lexington, KY, USA

    William B. Inabnet III

  3. Otolaryngology – Head and Neck Surgery, Johns Hopkins Medicine Otolaryngology – Head and Neck Surgery, Baltimore, MD, USA

    Ralph P. Tufano

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Mammen, J.S., Cooper, D.S. (2020). Lobectomy Versus Total Thyroidectomy in Suspicious or Malignant Thyroid Nodules. In: Russell, J., Inabnet III, W., Tufano, R. (eds) Transoral Neck Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-30722-6_6

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