Differentiated thyroid cancer: lobectomy and radioiodine, a treatment suitable for all cases?

When treating differentiated carcinoma of the thyroid, lobectomy is the minimum surgical requirement, but there is a strong case for ablation of the whole gland. Controversy centres on the management of the contralateral lobe, which may be ablated by total thyroidectomy, by near total thyroidectomy and ablation of thyroid fragments by 131I, or by 131I alone. Operative morbidity is increased after total thyroidectomy compared with lobectomy. However, radioactive 131I ablation of the contralateral lobe is associated with a longer period of hospitalization than if radioactive 131I is given to ablate residual fragments of thyroid tissue after total thyroidectomy. The use of lobectomy may lead to a higher incidence of patients requiring more than one administration of 131I. The evidence available indicates that radioactive 131I ablation of the contralateral lobe is a safe procedure unless tumour deposits within this lobe are large enough to be visualized on an ultrasound scan, when total thyroidectomy becomes mandatory. Clinical trials are necessary to test this hypothesis.