Endocrine Abstracts

The aims of effective surgical treatment of DTC are the provision of local control, the prevention of loco-regional relapse and when required the facilitation of adjuvant radioiodine therapy.

Best practice involves a requirement to tailor the extent of thyroid and lymph node surgery to the risk of local and systemic relapse and the avoidance of over treatment and morbidity related to the laryngeal nerves and parathyroid glands. A preoperative diagnosis of DTC allows the MDT to decide in advance the appropriate extent of thyroid surgery (lobectomy or total thyroidectomy).

As lymph node metastases in papillary thyroid cancer are most effectively treated by surgery, knowledge of node involvement prior to first time surgery – with the aid of ultrasound and guided FNA – reduces the requirement for reoperation and the increased risk of complications. The extent of node surgery should be appropriate for thyroid cancer, radical / modified radical neck dissection is rarely necessary.

In patients with extensive nodal involvement or locally advanced disease (invasion of the airway, oesophagus, recurrent laryngeal nerve) the surgeon should consider, and when appropriate perform a potentially curative resection to avoid treatment failure that results in death of the patient from compression of vital structures.