Treatment of thyroid malignancies.

Clinically significant thyroid malignancies are relatively uncommon, although their prevalence in autopsy series ranges up to 11%. New data confirm an increased incidence of carcinoma in solitary thyroid nodules in younger patients and a greater likelihood for younger patients to present with metastatic disease. Treatment of differentiated thyroid carcinoma is controversial, although many series indicate excellent results with total thyroidectomy. Although iodine-131 ablation has been standard in most centers after total thyroidectomy when residual thyroid tissues are present, new data indicate that selective use of this therapy may be appropriate. Prophylactic neck dissection does not improve survival or lessen recurrence in differentiated thyroid cancers and may increase morbidity. It should, therefore, be reserved for the patient with clinically enlarged cervical nodes.