Extent of surgery for differentiated thyroid cancer.

The authors believe that total or near total thyroidectomy followed by 131I ablation and thyroid hormone suppression therapy are there commended extent of surgery and treatment of choice in differentiated thyroid cancer. This is based on retrospective data showing that total thyroidectomy plus 131I and thyroid stimulating hormone (TSH) suppression reduces disease recurrence and mortality, removes all intrathyroidal cancer, and facilitates the use of 131I scans and thyroglobulin measurements to monitor for recurrence. Recent decision analyses supporting this recommendation are summarized in this article. The recommendation comes with the caveat that total thyroidectomy must be performed safely with a low complication rate. With the institution of this appropriate treatment regimen, the prognosis for the majority of our patients with differentiated thyroid cancer is excellent.