From the Guidelines
Thyroidectomy is indicated for malignancy, benign nodules or cysts, suspicious findings on fine needle aspiration biopsy, dysphagia from cervical esophageal compression, or dyspnea from airway compression.
Indications for Thyroidectomy
- Malignancy, such as anaplastic thyroid carcinoma, differentiated thyroid cancer, medullary thyroid cancer, and poorly differentiated thyroid cancer [ 1, 1 ]
- Benign nodules or cysts, particularly those that are symptomatic or have suspicious findings on fine needle aspiration biopsy 1
- Dysphagia from cervical esophageal compression or dyspnea from airway compression 1
- Total thyroidectomy is the initial treatment for differentiated thyroid carcinoma, whenever the diagnosis is made before surgery and the nodule is ≥1 cm, or regardless of the size and histology if there is metastatic, multifocal or familial disease 1
Surgical Considerations
- Total thyroidectomy with complete gross tumor resection should be attempted in patients with resectable disease 1
- Prophylactic central node dissection may be considered in cases of preoperatively suspected and/or intraoperatively proven lymph node metastases 1
- Compartment-oriented microdissection of lymph nodes should be performed in cases of preoperatively suspected and/or intraoperatively proven lymph node metastases 1
- Patients undergoing total thyroidectomy will require levothyroxine replacement therapy to maintain serum TSH concentration within the normal range 1
From the Research
Indications for Thyroidectomy
The indications for thyroidectomy, which is the surgical removal of the thyroid gland, include:
- Thyroid cancer, as total thyroidectomy is a safe procedure in the management of thyroid cancer 2
- Hyperthyroidism, with indications for surgical treatment including massive thyroid enlargement with compressive symptoms, a suspicious nodule, Graves' orbitopathy, and patient preference 3
- Benign thyroid diseases, such as goiter, with surgical management evolving to provide a framework for selecting appropriate surgical treatment 4
- Other thyroid pathologies, with evidence-based recommendations for safe, effective, and appropriate thyroidectomy 5
Specific Indications
Specific indications for thyroidectomy include:
- Papillary adenocarcinoma, follicular adenocarcinoma, and medullary carcinoma, as seen in a study of 51 patients with thyroid cancer 2
- Hyperthyroidism due to diffuse toxic goiter (Graves' disease), toxic multinodular goiter (Plummer disease), or a solitary toxic adenoma, with thyroidectomy being an option for treatment 3
- Thyroid diseases that require surgical management, with guidelines providing recommendations for the definitive surgical management of thyroid disease in adults 5
Surgical Management
The surgical management of thyroid disease continues to evolve, with:
- Improvements in techniques, diagnostics, understanding of anatomy, and technology allowing thyroid surgery to become a standard, effective, and safe surgery 6
- Total thyroidectomy being a safe procedure in the management of thyroid cancer, with skilled surgeons able to prevent major complications 2
- Evidence-based guidelines being created to assist clinicians in the optimal surgical management of thyroid disease 5