Surgery for the Solitary Thyroid Nodule

  • Prabhat K. Bhama
  • Gerard M. Doherty

8.5 Summary

Thyroid nodules are quite common, and the basis of their evaluation is the FNA cytology. However, some tumors cannot be completely characterized by FNA, and so require at minimum a diagnostic ipsilateral thyroid lobectomy for definitive histology. In such cases, complete lobectomy is the minimum procedure, to avoid the potential need for further operation on that side of the trachea.

Differentiated thyroid carcinoma is best treated by total thyroidectomy, which is safe in experienced hands. The best prognosis cancers can be managed by lobectomy alone with careful surveillance of the remaining lobe. Lateral neck dissection is reserved for clinically evident cancer involvement of that compartment, though central neck (level 6) node dissection should be a part of every initial thyroid cancer operation.


Thyroid Cancer Thyroid Carcinoma Papillary Thyroid Carcinoma Thyroid Nodule Papillary Thyroid 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Singer PA, et al (1996) Treatment guidelines for patients with thyroid nodules and well-differentiated thyroid cancer. American Thyroid Association. Arch Int Med 156:2165–2172CrossRefGoogle Scholar
  2. 2.
    Kumar H, et al (1999) Gender, clinical findings, and serum thyrotropin measurements in the prediction of thyroid neoplasia in 1005 patients presenting with thyroid enlargement and investigated by fine-needle aspiration cytology. Thyroid 9:1105–1109PubMedGoogle Scholar
  3. 3.
    Gharib H, Goellner JR, Johnson DA (1993) Fine-needle aspiration cytology of the thyroid. A 12-year experience with 11,000 biopsies. Clin Lab Med 13:699–709PubMedGoogle Scholar
  4. 4.
    Cersosimo E, et al (1993) “Suspicious” thyroid cytologic findings: outcome in patients without immediate surgical treatment. Mayo Clin Proc 68:343–348PubMedGoogle Scholar
  5. 5.
    Nagai GR, et al (1987) Scintigraphic hot nodules and thyroid carcinoma. Clin Nucl Med 12:123–127PubMedCrossRefGoogle Scholar
  6. 6.
    Smith J, et al (2005) Can cytology accurately predict benign follicular nodules? Am J Surg 189:592–5; discussion 595PubMedCrossRefGoogle Scholar
  7. 7.
    Soh EY, Clark OH (1996) Surgical considerations and approach to thyroid cancer. Endocrinol Metab Clin North Am 25:115–139PubMedCrossRefGoogle Scholar
  8. 8.
    Udelsman R, Shaha AR (2005) Is total thyroidectomy the best possible surgical management for well-differentiated thyroid cancer? Lancet Oncol 6:529–531PubMedCrossRefGoogle Scholar
  9. 9.
    Udelsman R (2004) Experience counts [comment]. Ann Surg 240:26–27PubMedCrossRefGoogle Scholar
  10. 10.
    Sosa JA, et al (1998) The importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg 228:320–330PubMedCrossRefGoogle Scholar
  11. 11.
    Reeve T, Thompson NW (2000) Complications of thyroid surgery: how to avoid them, how to manage them, and observations on their possible effect on the whole patient. World J Surg 24:971–975PubMedCrossRefGoogle Scholar
  12. 12.
    Ley PB, et al (1993) Safety and efficacy of total thyroidectomy for differentiated thyroid carcinoma: a 20-year review. Am Surg 59:110–114PubMedGoogle Scholar
  13. 13.
    Katoh R, et al (1992) Multiple thyroid involvement (intraglandular metastasis) in papillary thyroid carcinoma. A clinicopathologic study of 105 consecutive patients. Cancer 70:1585–1590PubMedCrossRefGoogle Scholar
  14. 14.
    Pellegriti G, et al (2004) Clinical behavior and outcome of papillary thyroid cancers smaller than 1.5 cm in diameter: study of 299 cases [see comment]. J Clin Endocrinol Metab 89:3713–3720PubMedCrossRefGoogle Scholar
  15. 15.
    Pacini F, et al (2001) Contralateral papillary thyroid cancer is frequent at completion thyroidectomy with no difference in low-and high-risk patients [see comment]. Thyroid 11:877–881PubMedCrossRefGoogle Scholar
  16. 16.
    Hay ID, et al (1998) Unilateral total lobectomy: is it sufficient surgical treatment for patients with AMES low-risk papillary thyroid carcinoma? Surgery 124:958–964; discussion 964–966PubMedGoogle Scholar
  17. 17.
    Tollefson HR, Shah JP, Huvos AJ (1972) Papillary carcinoma of the thyroid. Recurrence in the thyroid gland after initial treatment. Am J Surg 124:468–472CrossRefGoogle Scholar
  18. 18.
    Silverberg SG, Hutter RV, Foote FW Jr (1970) Fatal carcinoma of the thyroid: histology, metastases, and causes of death. Cancer 25:792–802PubMedCrossRefGoogle Scholar
  19. 19.
    Samaan NA, et al (1992) The results of various modalities of treatment of well differentiated thyroid carcinomas: a retrospective review of 1599 patients. J Clin Endocrinol Metab 75:714–720PubMedCrossRefGoogle Scholar
  20. 20.
    DeGroot LJ, et al (1990) Natural history, treatment, and course of papillary thyroid carcinoma. J Clin Endocrinol Metab 71:414–424PubMedCrossRefGoogle Scholar
  21. 21.
    Flynn MB, et al (1994) Local complications after surgical resection for thyroid carcinoma. Am J Surg 168:404–407PubMedCrossRefGoogle Scholar
  22. 22.
    Pisanu A, et al (2005) Hypocalcemia following total thyroidectomy: early factors predicting long-term outcome. Giornale di Chirurgia 26:131–134PubMedGoogle Scholar
  23. 23.
    Schroder DM, Chambous A, France CJ (1986) Operative strategy for thyroid cancer, is total thyroidectomy worth the price? Cancer 58:2320PubMedCrossRefGoogle Scholar
  24. 24.
    Haigh PI, Urbach DR, Rotstein LE (2005) Extent of thyroidectomy is not a major determinant of survival in low-or high-risk papillary thyroid cancer. Ann Surg Oncol 12:81–89PubMedCrossRefGoogle Scholar
  25. 25.
    Dietlein M, et al (2005) Incidental multifocal papillary microcarcinomas of the thyroid: is subtotal thyroidectomy combined with radioiodine ablation enough? Nucl Med Commun 26:3–8PubMedCrossRefGoogle Scholar
  26. 26.
    Rosato L, et al (2004) Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 28:271–276PubMedCrossRefGoogle Scholar
  27. 27.
    Akslen LA (1993) Prognostic importance of histologic grading in papillary thyroid carcinoma. Cancer 72:2680–2685PubMedCrossRefGoogle Scholar
  28. 28.
    Akslen LA, et al (1991) Survival and causes of death in thyroid cancer: a population-based study of 2479 cases from Norway. Cancer Res 51:1234–1241PubMedGoogle Scholar
  29. 29.
    Mirallie E, et al (1999) Localization of cervical node metastasis of papillary thyroid carcinoma. World J Surg 23:970–973; discussion 973–974PubMedCrossRefGoogle Scholar
  30. 30.
    Gemsenjager E, et al (2003) Lymph node surgery in papillary thyroid carcinoma. J Am Coll Surg 197:182–190PubMedCrossRefGoogle Scholar
  31. 31.
    Tisell LE (1998) Role of lymphadenectomy in the treatment of differentiated thyroid carcinomas. Br J Surg 85:1025–1026PubMedCrossRefGoogle Scholar
  32. 32.
    Tisell LE, et al (1996) Improved survival of patients with papillary thyroid cancer after surgical microdissection. World J Surg 20:854–859PubMedCrossRefGoogle Scholar
  33. 33.
    Cooper D, et al (2006) Treatment guidelines for patients with thyroid nodules and well-differentiated thyroid cancer. American Thyroid Association. Thyroid 16:109–42PubMedGoogle Scholar
  34. 34.
    Cooper DS, Schneyer CR (1990) Follicular and Hürthle cell carcinoma of the thyroid. Endocrinol Metab Clin North Am 19:577–591PubMedGoogle Scholar
  35. 35.
    Ron E, et al (1995) Thyroid cancer after exposure to external radiation: a pooled analysis of seven studies. Radiat Res 141:259–277PubMedCrossRefGoogle Scholar
  36. 36.
    Ron E, Modan B (1980) Benign and malignant thyroid neoplasms after childhood irradiation for tinea capitis. J Natl Cancer Inst 65:7–11PubMedGoogle Scholar
  37. 37.
    Shore RE (1992) Issues and epidemiological evidence regarding radiation-induced thyroid cancer. Radiat Res 131:98–111PubMedCrossRefGoogle Scholar
  38. 38.
    Shore RE, et al (1993) Thyroid cancer among persons given X-ray treatment in infancy for an enlarged thymus gland. Am J Epidemiol 137:1068–1080PubMedGoogle Scholar
  39. 39.
    Cetta F, et al (2001) Thyroid carcinoma usually occurs in patients with familial adenomatous polyposis in the absence of biallelic inactivation of the adenomatous polyposis coli gene. J Clin Endocrinol Metab 86:427–432PubMedCrossRefGoogle Scholar
  40. 40.
    Cetta F, et al (2000) Germline mutations of the APC gene in patients with familial adenomatous polyposis-associated thyroid carcinoma: results from a European cooperative study. J Clin Endocrinol Metab 85:286–292PubMedCrossRefGoogle Scholar
  41. 41.
    Bacher-Stier C, et al (1997) Incidence and clinical characteristics of thyroid carcinoma after iodine prophylaxis in an endemic goiter country. Thyroid 7:733–741PubMedCrossRefGoogle Scholar
  42. 42.
    Mazzaferri EL, Jhiang SM (1994) Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer [see comment] [erratum appears in Am J Med 1995 98:215]. Am J Med 97:418–428PubMedCrossRefGoogle Scholar
  43. 43.
    Akslen LA, LiVolsi VA (2000) Prognostic significance of histologic grading compared with subclassification of papillary thyroid carcinoma [see comment]. Cancer 88:1902–1908PubMedCrossRefGoogle Scholar
  44. 44.
    Thompson NW, Nishiyama RH, Harness JK (1978) Thyroid carcinoma: current controversies. Curr Probl Surg 15:1–67Google Scholar
  45. 45.
    Clark OH, et al (1988) Thyroid cancer: the case for total thyroidectomy. Eur J Cancer Clin Oncol 24:305–313PubMedCrossRefGoogle Scholar
  46. 46.
    Tartaglia F, et al (2003) Complications in total thyroidectomy: our experience and a number of considerations. Chir Ital 55:499–510PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2007

Authors and Affiliations

  • Prabhat K. Bhama
    • 1
  • Gerard M. Doherty
    • 1
    • 2
  1. 1.Division of Endocrine SurgeryUniversity of Michigan Medical SchoolAnn Arbor
  2. 2.2920B Taubman Health Care CenterAnn ArborUSA

Personalised recommendations