Skip to main content

Completion Thyroidectomy in a Patient with Low-Risk Papillary Cancer

  • Chapter
  • First Online:
Thyroid Cancer
  • 645 Accesses

Abstract

Recent adoption of a new thyroid cytopathology reporting system (the Bethesda system) and current clinical practice guidelines have led to a large number of patients with indeterminate thyroid nodules undergoing diagnostic thyroid lobectomy. If such patients are found to have papillary thyroid cancer on final pathology, the question of completion thyroidectomy is often raised. In general, patients who have undergone a lobectomy in this situation and are found to have thyroid cancer will typically have low-risk disease. In such cases, there is little compelling evidence to recommend completion thyroidectomy, to either decrease recurrence rates or allow radioiodine remnant ablation. Therefore, for patients with low-risk thyroid cancer who have undergone lobectomy, follow-up without additional surgery, using serum thyroglobulin measurements and neck ultrasound to monitor for recurrence, is recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Bongiovanni M, Spitale A, Faquin WC, Mazzucchelli L, Baloch ZW. The Bethesda system for reporting thyroid cytopathology: a meta-analysis. Acta Cytol. 2012;56:333–9.

    Article  Google Scholar 

  2. Patel KN, Angell TE, Babiarz J, et al. Performance of a genomic sequencing classifier for the preoperative diagnosis of cytologically indeterminate thyroid nodules. JAMA Surg. 2018;153:817–24.

    Article  Google Scholar 

  3. Steward DL, Carty SE, Sippel RS, et al. Performance of a multigene genomic classifier in thyroid nodules with indeterminate cytology: a prospective blinded multicenter study. JAMA Oncol. 2019;5:204–12.

    Article  Google Scholar 

  4. Park S, Jeon MJ, Oh HS, et al. Changes in serum thyroglobulin levels after lobectomy in patients with low-risk papillary thyroid cancer. Thyroid. 2018;28:997–1003.

    Article  CAS  Google Scholar 

  5. Kim ES, Kim TY, Koh JM, Kim YI, Hong SJ, Kim WB, Shong YK. Completion thyroidectomy in patients with thyroid cancer who initially underwent unilateral operation. Clin Endocrinol. 2004;61:145–8.

    Article  Google Scholar 

  6. Vaisman F, Shaha A, Fish S, Tuttle RM. Initial therapy with either thyroid lobectomy or total thyroidectomy without radioactive iodine remnant ablation is associated with very low rates of structural disease recurrence in properly selected patients with differentiated thyroid cancer. Clin Endocrinol. 2011;75:112–9.

    Article  CAS  Google Scholar 

  7. Randolph GW, Duh QY, Heller KS, LiVolsi VA, Mandel SJ, Steward DL, Tufano RP, Tuttle RM, American Thyroid Association Surgical Affairs Committee’s Taskforce on Thyroid Cancer Nodal Surgery. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid. 2012;22:1144–52.

    Article  Google Scholar 

  8. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–214.

    Article  Google Scholar 

  9. Hay ID, Grant CS, Bergstralh EJ, Thompson GB, van Heerden JA, Goellner JR. Unilateral total lobectomy: is it sufficient surgical treatment for patients with AMES low-risk papillary thyroid carcinoma? Surgery. 1998;124:958–64.

    Article  CAS  Google Scholar 

  10. Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS, Sturgeon C. Extent of surgery affects survival for papillary thyroid cancer. Ann Surg. 2007;246:375–81.

    Article  Google Scholar 

  11. Shaha AR. Extent of surgery for papillary thyroid carcinoma: the debate continues: comment on “surgery for papillary thyroid carcinoma”. Arch Otolaryngol Head Neck Surg. 2010;136:1061–3.

    Article  Google Scholar 

  12. Mendelsohn AH, Elashoff DA, Abemayor E, St John MA. Surgery for papillary thyroid carcinoma: is lobectomy enough? Arch Otolaryngol Head Neck Surg. 2010;136:1055–61.

    Article  Google Scholar 

  13. Nixon IJ, Ganly I, Patel SG, Palmer FL, Whitcher MM, Tuttle RM, Shaha A, Shah JP. Thyroid lobectomy for treatment of well differentiated intrathyroid malignancy. Surgery. 2012;151:571–9.

    Article  Google Scholar 

  14. Adam MA, Pura J, Gu L, et al. Extent of surgery for papillary thyroid cancer is not associated with survival: an analysis of 61,775 patients. Ann Surg. 2014;260:601–7.

    Article  Google Scholar 

  15. Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–133.

    Article  Google Scholar 

  16. Hauch A, Al-Qurayshi Z, Randolph G, Kandil E. Total thyroidectomy is associated with increased risk of complications for low- and high-volume surgeons. Ann Surg Oncol. 2014;21:3844–52.

    Article  Google Scholar 

  17. Untch BR, Palmer FL, Ganly I, Patel SG, Tuttle RM, Shah JP, Shaha AA. Oncologic outcomes after completion thyroidectomy for patients with well-differentiated thyroid carcinoma. Ann Surg Oncol. 2014;21:1374–8.

    Article  Google Scholar 

  18. Nikiforov YE. Role of molecular markers in thyroid nodule management: then and now. Endocr Pract. 2017;23:979–88.

    Article  Google Scholar 

  19. Lee DY, Seok J, Jeong WJ, Ahn SH. Prediction of thyroid hormone supplementation after thyroid lobectomy. J Surg Res. 2015;193:273–8.

    Article  CAS  Google Scholar 

  20. Zatelli MC, Lamartina L, Meringolo D, et al. Thyroid nodule recurrence following lobo-isthmectomy: incidence, patient’s characteristics, and risk factors. J Endocrinol Investig. 2018;41:1469–75.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to David S. Cooper .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Cooper, D.S. (2021). Completion Thyroidectomy in a Patient with Low-Risk Papillary Cancer. In: Grani, G., Cooper, D.S., Durante, C. (eds) Thyroid Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-61919-0_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-61919-0_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-61918-3

  • Online ISBN: 978-3-030-61919-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics