Can a combined surgery involving hemithyroidectomy (removal of half of the thyroid gland) be performed for a patient with squamous cell carcinoma (SCC) of the tongue and a thyroid nodule?

Combined Surgery with Hemithyroidectomy for Squamous Cell Carcinoma of the Tongue and Thyroid Nodule

A combined surgery involving hemithyroidectomy can be safely performed for a patient with squamous cell carcinoma (SCC) of the tongue and a thyroid nodule, provided there is appropriate preoperative assessment and multidisciplinary planning.

Preoperative Considerations

Assessment of Both Conditions

• Complete staging of the tongue SCC should include:
  • Physical examination
  • Head and neck endoscopy
  • Head and neck CT scan or MRI
  • Thoracic CT scan to rule out metastatic disease 1
• Thyroid nodule evaluation:
  • Ultrasound characterization
  • Fine needle aspiration if indicated based on size/characteristics
  • Thyroid function tests

Surgical Planning

• Multidisciplinary team discussion is essential to coordinate the combined approach
• Nutritional status must be corrected and maintained prior to surgery 1, 2
• Dental rehabilitation is indicated prior to radiotherapy if that will be part of post-operative management 1, 2

Surgical Approach

Primary Tumor Management

• For tongue SCC:
  • Transoral approach for early-stage disease
  • More extensive resection for advanced disease
  • Neck dissection should include levels II-IV 1
  • For tonsillar tumors: ipsilateral neck dissection
  • For tongue base tumors: bilateral neck dissection 1

Thyroid Component

• Hemithyroidectomy can be performed during the same procedure
• The surgical approach should be planned to:
  • Minimize additional incisions
  • Optimize exposure for both procedures
  • Allow for adequate margins for both tumors

Post-operative Management

Adjuvant Therapy Considerations

• For tongue SCC:
  • Adjuvant radiotherapy or chemoradiotherapy based on pathologic risk factors:
    • Positive margins
    • Extranodal extension
    • Multiple positive nodes
    • Perineural invasion 1, 2
  • Platinum-based regimens remain standard for concurrent chemoradiotherapy 1, 2

Follow-up Protocol

• Regular surveillance for both primary sites:
  • Physical examination every 3-6 months for first 2 years
  • Radiologic imaging as clinically indicated
  • Evaluation of thyroid function at 1,2, and 5 years if radiation was delivered to the neck 2

Special Considerations

Rare Associations

• Cases of simultaneous SCC and thyroid pathology have been reported, though rare 3, 4
• In some cases, papillary thyroid carcinoma has been incidentally found in cervical lymph nodes during neck dissection for tongue SCC 5
• When thyroid carcinoma is found incidentally during HNSCC surgery, further thyroid-specific treatment may not be necessary if the thyroid tissue was included in the surgical specimen 6

Potential Complications

• Increased operative time
• Risk of hypoparathyroidism (temporary or permanent)
• Recurrent laryngeal nerve injury
• Need for thyroid hormone replacement therapy
• Wound healing complications if radiation is required postoperatively

Conclusion

Combined surgery for tongue SCC and hemithyroidectomy is feasible with proper planning. The surgical approach should be tailored to ensure adequate oncologic resection of both lesions while minimizing morbidity. Postoperative management should address both conditions with appropriate surveillance and adjuvant therapy as indicated by pathologic findings.