Surgery

Thyroid Factor

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The mainstay of treatment for differentiated thyroid cancer is surgery. The adequacy of the surgical procedure is an important factor determining the outcome: Mazzaferri and Jhiang [9] found a significant difference in mortality rate in patients who received less than near-total thyroidectomy (Figure 2.1), and Hay et al. [13] found a highly significant difference in recurrence rate between unilateral lobectomy and bilateral lobar resection (Figure 2.2).

Patients at risk Yeara Atter lni'«" Therapy

Less than 52© 351 215 73 7

Near-total 70S 435 34S 110 6

Figure 2.1 Disease-specific mortality in patients treated with total or near-total thyroidectomy compared with patients who underwent less extensive surgery.(Reproduced from Mazzaferri EL,Thyroid cancer: impact of therapeutic modalities on prognosis, Chapter 10 in Thyroid Cancer (ed. Fagin JA), Kluwer Academic Publishers, Boston/Dordrecht London, 1998, pages 255-284.)

Patients at risk Yeara Atter lni'«" Therapy

Less than 52© 351 215 73 7

Near-total 70S 435 34S 110 6

Figure 2.1 Disease-specific mortality in patients treated with total or near-total thyroidectomy compared with patients who underwent less extensive surgery.(Reproduced from Mazzaferri EL,Thyroid cancer: impact of therapeutic modalities on prognosis, Chapter 10 in Thyroid Cancer (ed. Fagin JA), Kluwer Academic Publishers, Boston/Dordrecht London, 1998, pages 255-284.)

Patients with a small cancer of 1 cm diameter or less and node negative can be adequately treated by lobectomy followed by TSH suppression (T4 therapy). Lobectomy alone may also be appropriate treatment for certain other cases known to be at low risk, but this decision should be endorsed by the MDT.

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