Papillary carcinoma of the thyroid gland.

The results of this analysis have demonstrated that papillary carcinoma of the thyroid gland rarely causes the death of the patient. Bilateral subtotal lobectomies, partial lobectomies and probably total lobectomy combined with contralateral partial lobectomy should not be performed in the treatment of this disease. The incidence of local recurrence is higher after these procedures, and any subsequent operative procedure is complicated by scarring secondary to the initial procedure. Total lobectomy is the procedure of choice for patients with disease confined to one lobe on palpation. Total thyroidectomy should only be performed for palpable disease in both lobes. Excision of a grossly normal contralateral lobe solely to obtain microscopic tumor which rarely becomes clinically apparent is not worth the inherent risk of bilateral recurrent palsy of the nerve or permanent hypoparathyroidism. Cervical metastasis of the lymph nodes which are detected either synchronously or during subsequent follow-up examination can almost always be resected by some type of modified neck dissection. A radical neck dissection with the resection of the jugular vein and the sternocleidomastoid muscle is rarely if ever necessary. The administration of thyroid hormone as a surgical adjuvant may not be of any benefit and its routine use is probably not necessary.