Thyroid adenoma surgery
|
Thyroid adenoma Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Thyroid adenoma surgery On the Web |
|
American Roentgen Ray Society Images of Thyroid adenoma surgery |
|
Risk calculators and risk factors for Thyroid adenoma surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]
Overview
Thyroid lobectomy or thyroidectomy is recommended for all patients who develop pressure symptoms of thyroid adenoma.
Surgery
- The minimal surgical procedure is a thyroid lobectomy, removing all thyroid tissue on the side of the lesion.
Indications in patients with goiter without nodules:
- Reasonable suspicion of malignancy, with:
- Hard, firm, and potentially fast growing fixed nodule(s)
- Cervical lymphadenopathy
- Ultrasound high-risk lesion classified as category 4c and 5 of thyroid imaging, reporting and data system classification (TI-RADS)
- Fine needle aspiration cytology (FNAC) class suspicious/positive according to Schmid classification or class 4–5 according to Bethesda classification
- FNAC class requiring further investigations according to Schmid classification or FNAC class 3 according to Bethesda classification, in the presence of indicators of malignancy
- Basal calcitonin serum level increase ( >26 pmol/L in women and 60 pmol/L in men)
- Presence of compression symptoms
Indications
- Ultrasound lesions with moderate risk according to thyroid imaging, reporting and data system classification (TI-RADS), if the patient does not wish to undergo regular follow-up
- Past exposure to radiation
- Fine needle aspiration cytology class suspicious requiring further investigations according to Schmid classification or class 3 according to Bethesda classification, as an alternative to monitoring at close intervals (even if no other indicators of malignancy are present)
- Thyroid nodules and positive immediate family history for thyroid carcinoma
- Subclinical or overt hyperthyroidism based on functional autonomy as an alternative to radioiodine therapy, if the latter is contraindicated or not reasonable or refused by the patient
- For prevention of complications with progressive retrosternal growth (tracheal compression >35%, superior vena cava syndrome)
- For cosmetic reasons with visible goiter
Contraindications:
- Ssymptomatic euthyroid nodular goiter without suspicion of malignancy
- “Cold” nodule on scintigraphy without further indicators of malignancy or other reasons to operate