In a patient with multinodular goitre ( non toxic and no compressive symptoms) , with a single suspicious nodule (2 cm) on ultrasonography and cytology of that nodule as Bethesda V ( suspicious of papillary carcinoma), what would the extent of initial surgery be? Hemithyroidectomy? Total thyroidectomy?
The contralateral lobe has multiple nodules( majority are subcentimeter and few between 1-1.5 cm), all appear benign on ultrasound.
It is a difficult decision, the chances of malignancy are high in this case but there is no definitive diagnosis. Intraoperative biopsy may be useful, if it is cancer, I would be inclined for a total thyroidectomy because although the nodules are benign in appearance, the frequent multicentricity is well known in case of a papillary carcinoma. If the intraoperative biopsy does not help in the diagnosis, the patient will have to weigh the possibility of a new surgery vs taking hormonal treatment for the rest of his life and the complication rate of the center where he will be treated. Ultimately I think it is a decision of the patient.
If the biopsy is performed by experienced clinicin and examined by experienced pathologist total thyroidectomy should be performed.
Thank you for the replies.
What if the contralatetal lobe is normal? Will you do a lobectomy/hemithyroidectomy or total thyroidectomy?
If the contralateral lobe is normal and is not an unfavorable histological variety, for a lesion of that size both procedures are acceptable
In the case of Bethesda Class V cytology associated with multinodular goiter, I think that the treatment depends on the result of the biopsy practiced during the surgical procedure. If the result of the biopsy does not confirm the diagnosis of malignancy I would rather favor a subtotal thyroidectomy, which includes the suspicious nodule and of course as the treatment of choice for the multinodular goiter. I favor a subtotal rather than a total thyroidectomy in multinodular goiter because the frequency of hypoparathyroidism is less in the case of subtotal rather than total thyroidectomy.
If the result during the surgical procedure confirms the diagnosis of papillary thyroid carcinoma I would advise a total thyroidectomy with examination of the nearby nodes and adding a radical therapeutic procedure in the case they are involved.
Before agreeing on whether total or hemi. Please check for metastases and if none, hemithyroidectomy is better.
In my opinion between practicing hemithyroidectomy of total thyroidectomy in the case of a 2-centimeter malignant papillary lesion, I think that it would depend on the histologic result of the biopsy practiced during the surgical procedure. In the case of an aggressive lesion (tall cell or an insular variant of papillary thyroid carcinoma), I would favor a total thyroidectomy but in the case of an encapsulated papillary or follicular variant of papillary thyroid carcinoma, I would agree that hemithyroidectomy is sufficient.
- Badges
- Science method
- Similar topics
- Biological Science
- General Biochemistry
- Biochemical Techniques
- Cytology