Thyroid cancer--surgical decision making.

Although there are arguments for different approaches, we have presented a format based upon the current literature and our clinical experiences for the management for thyroid nodules and cancers. The limited value of suppressive therapy in solitary nodules is stressed. Lobectomy with isthmectomy is the initial surgical procedure for dominant nodules. Total thyroidectomy for proven thyroid cancers is performed when possible. Regional lymph nodes in the central or visceral compartment are removed therapeutically by a modified technique in order to prevent significant functional loss and deformity. In the postoperative period, radioactive iodine therapy can be extremely beneficial. Postoperative thyroid suppressive therapy is useful in patients with thyroid cancer although a third or more of these tumors will eventually escape from beneficial effects. Clinical experiences of recurrent or metastatic thyroid cancer regressions following suppression therapy are difficult to document.