Thyroid adenoma surgery: Difference between revisions
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==Surgery== | ==Surgery== | ||
* The minimal surgical procedure is a thyroid [[lobectomy]], removing all [[thyroid]] tissue on the side of the lesion. | * 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=== | ===Indications=== | ||
* Ultrasound lesions with moderate risk according to TI-RADS | * 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 | * 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 | * 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 | * 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 prevention of complications with progressive retrosternal growth (tracheal compression >35%, superior vena cava syndrome) | ||
* For cosmetic reasons with visible goiter | * 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 | |||
* | * | ||
Revision as of 20:52, 28 February 2019
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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