Surgery for advanced thyroid malignancy.

Advanced thyroid malignancy can occur early in the course of the disease, or as late as 20 to 25 years after the initial diagnosis. The basic treatment is total thyroidectomy with central node dissection regardless of the histologic type. the nonresectable disease is treated with 131I if the tumor has iodine uptake. Further ablative surgery for resectable disease is governed by location and histologic cell type. Otherwise external radiation and chemotherapy (Adriamycin) is used. Anaplastic, primary squamous cell, and pure papillary and some predominantly papillary carcinomas and some Hürthle cell carcinomas do not have 131I uptake and fall into this latter category. The surgeon must be aware of this problem in the noniodine uptake tumors and take special care to remove all surgically resectable disease.