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Surgical Treatment of Papillary and Follicular Thyroid Cancer

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Management of Differentiated Thyroid Cancer

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Abstract

The treatment of differentiated follicular-derived thyroid cancer (papillary and follicular thyroid cancer) generally includes thyroidectomy with or without lymph node excision followed by adjuvant treatment with radioiodine for selected cases. Thyroidectomy requires knowledge of anatomy, avoidance of blood loss, identification and preservation of the recurrent laryngeal nerves, and preservation of viable parathyroid glands. The extent of surgery is dependent on the extent of disease as dictated by the primary tumor and the presence of metastatic cervical lymph nodes. This is tempered by demands of safety and avoidance of surgical complications. Accurate preoperative staging, including preoperative imaging with ultrasound which includes the lateral neck compartments to determine extent of disease, is paramount to performing the appropriate extent of surgery to reduce the risk of persistent disease. In experienced hands thyroidectomy has low complication rates which primarily include hypoparathyroidism related to devascularization of parathyroid tissue and voice dysfunction related to injury of the superior or recurrent laryngeal nerves. Postoperative hypoparathyroidism presents with symptoms of hypocalcemia which are typically transient and can be treated with calcium and vitamin D supplementation. Recurrent laryngeal nerve palsy related to neurapraxia will typically resolve over several months; however anatomic disruption of the nerve will result in permanent voice dysfunction. This chapter discusses the preoperative assessment, operative approach, and postoperative management of papillary and follicular thyroid cancer.

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Abbreviations

FNA:

Fine needle aspirate

PTH:

Parathyroid hormone

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Authors and Affiliations

  1. Division of Endocrine Surgery, Department of Surgery, University of Michigan, University of Michigan Hospitals and Health Centers, 2920 Taubman Center, SPC 5331, 1500 East Medical Center Drive, Ann Arbor, MI, 48109-5331, USA

    David T. Hughes M.D. & Paul G. Gauger M.D.

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  1. David T. Hughes M.D.
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  2. Paul G. Gauger M.D.
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Correspondence to David T. Hughes M.D. .

Editor information

Editors and Affiliations

  1. General Surgery, Central Arkansas Veterans Healthcare System, University of Arkansas, Little Rock, Arkansas, USA

    Anne T. Mancino

  2. Division of Surgical Oncology, University of North Carolina, Chapel Hill, North Carolina, USA

    Lawrence T. Kim

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Hughes, D.T., Gauger, P.G. (2017). Surgical Treatment of Papillary and Follicular Thyroid Cancer. In: Mancino, A., Kim, L. (eds) Management of Differentiated Thyroid Cancer. Springer, Cham. https://doi.org/10.1007/978-3-319-54493-9_12

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  • DOI: https://doi.org/10.1007/978-3-319-54493-9_12

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-54492-2

  • Online ISBN: 978-3-319-54493-9

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