Surgical treatment for thyroid cancer.

Thyroid cancer, although a rare disease, may cause significant disability and even death. Its proper surgical management is based on an understanding of the different biolgoic behavior of the four subtypes. Papillary and follicular cancers are best managed by total lobectomy on the side of the lesion and subtotal lobectomy on the contralateral side, unless there is gross disease bilaterally or distant metastasis (in which circumstances total thyroidectomy is performed). Cervical lymph node metastasis, when present, is handled satisfactorily by modified neck dissection. Because of its high incidence of multicentricity and its more serious prognosis, medullary thyroid carcinoma is managed by total thyroidectomy and--usually--radical neck dissection for involved nodes. For anaplastic carcinoma, there is no effective treatment at present. Postoperatively, all patients should be given suppressive doses of thyroid hormone to prevent myxedema and to prevent cancer from recurring. Radioiodine therapy may be of value in suppressing metastasis of some papillary and follicular cancers that exhibit a high degree of follicular differentiation.