Thyroid adenoma surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Roukoz A. Karam, M.D.[2]; Ammu Susheela, M.D. [3]
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:[1][2][3]
- 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:[1][3][2]
- 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:[1]
- Asymptomatic euthyroid nodular goiter without suspicion of malignancy.
- “Cold” nodule on scintigraphy without further indicators of malignancy or other reasons to operate.
References
- ↑ 1.0 1.1 1.2 Bartsch DK, Luster M, Buhr HJ, Lorenz D, Germer CT, Goretzki PE; et al. (2018). "Indications for the Surgical Management of Benign Goiter in Adults". Dtsch Arztebl Int. 115 (1–02): 1–7. doi:10.3238/arztebl.2018.0001. PMC 5778395. PMID 29345225.
- ↑ 2.0 2.1 Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH; et al. (2011). "Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk". Radiology. 260 (3): 892–9. doi:10.1148/radiol.11110206. PMID 21771959.
- ↑ 3.0 3.1 Cibas ES, Ali SZ, NCI Thyroid FNA State of the Science Conference (2009). "The Bethesda System For Reporting Thyroid Cytopathology". Am J Clin Pathol. 132 (5): 658–65. doi:10.1309/AJCPPHLWMI3JV4LA. PMID 19846805.