Thyroid adenoma surgery: Difference between revisions

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__NOTOC__
__NOTOC__
{{Thyroid adenoma}}
{{Thyroid adenoma}}
{{CMG}}; {{AE}} {{Ammu}}
{{CMG}}; {{AE}} {{RAK}}; {{Ammu}}
==Overview==
==Overview==
Thyroid [[lobectomy]] or thyroidectomy is recommended for all patients who develop pressure [[symptom]]s of thyroid adenoma.
Thyroid [[lobectomy]] or thyroidectomy is recommended for all patients who develop pressure [[symptom]]s of thyroid [[adenoma]].
==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:'''<ref name="pmid293452252">{{cite journal| author=Bartsch DK, Luster M, Buhr HJ, Lorenz D, Germer CT, Goretzki PE et al.| title=Indications for the Surgical Management of Benign Goiter in Adults. | journal=Dtsch Arztebl Int | year= 2018 | volume= 115 | issue= 1-02 | pages= 1-7 | pmid=29345225 | doi=10.3238/arztebl.2018.0001 | pmc=5778395 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29345225  }}</ref><ref name="pmid21771959">{{cite journal| author=Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH et al.| title=Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. | journal=Radiology | year= 2011 | volume= 260 | issue= 3 | pages= 892-9 | pmid=21771959 | doi=10.1148/radiol.11110206 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21771959  }} </ref><ref name="pmid19846805">{{cite journal| author=Cibas ES, Ali SZ, NCI Thyroid FNA State of the Science Conference| title=The Bethesda System For Reporting Thyroid Cytopathology. | journal=Am J Clin Pathol | year= 2009 | volume= 132 | issue= 5 | pages= 658-65 | pmid=19846805 | doi=10.1309/AJCPPHLWMI3JV4LA | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19846805  }} </ref> =====
===== '''Indications in patients with goiter without nodules:'''<ref name="pmid293452252">{{cite journal| author=Bartsch DK, Luster M, Buhr HJ, Lorenz D, Germer CT, Goretzki PE et al.| title=Indications for the Surgical Management of Benign Goiter in Adults. | journal=Dtsch Arztebl Int | year= 2018 | volume= 115 | issue= 1-02 | pages= 1-7 | pmid=29345225 | doi=10.3238/arztebl.2018.0001 | pmc=5778395 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29345225  }}</ref><ref name="pmid21771959">{{cite journal| author=Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH et al.| title=Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. | journal=Radiology | year= 2011 | volume= 260 | issue= 3 | pages= 892-9 | pmid=21771959 | doi=10.1148/radiol.11110206 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21771959  }} </ref><ref name="pmid19846805">{{cite journal| author=Cibas ES, Ali SZ, NCI Thyroid FNA State of the Science Conference| title=The Bethesda System For Reporting Thyroid Cytopathology. | journal=Am J Clin Pathol | year= 2009 | volume= 132 | issue= 5 | pages= 658-65 | pmid=19846805 | doi=10.1309/AJCPPHLWMI3JV4LA | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19846805  }} </ref> =====
* Reasonable suspicion of malignancy, with:
* Reasonable suspicion of [[malignancy]], with:
** Hard, firm, and potentially fast growing fixed nodule(s)
** Hard, firm, and potentially fast growing fixed nodule(s)
** Cervical lymphadenopathy
** Cervical [[lymphadenopathy]]
** Ultrasound high-risk lesion classified as category 4c and 5 of thyroid imaging, reporting and data system classification (TI-RADS)
** 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
** 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
** 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)
** Basal [[calcitonin]] serum level increase ( >26 pmol/L in women and 60 pmol/L in men)
* Presence of compression symptoms
* Presence of compression [[symptoms]]


====Indications<ref name="pmid293452252" /><ref name="pmid19846805" /><ref name="pmid21771959" />====
====Indications:<ref name="pmid293452252" /><ref name="pmid19846805" /><ref name="pmid21771959" />====
* 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
* [[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)
* 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:<ref name="pmid293452252" />''' ====
==== '''Contraindications:<ref name="pmid293452252" />''' ====
* Asymptomatic euthyroid nodular goiter without suspicion of malignancy
* Asymptomatic [[euthyroid]] nodular [[goiter]] without suspicion of [[malignancy]].
* “Cold” nodule on scintigraphy without further indicators of malignancy or other reasons to operate
* “Cold” nodule on [[scintigraphy]] without further indicators of [[malignancy]] or other reasons to operate.


*  
*  

Latest revision as of 04:30, 1 May 2019

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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]

References

  1. 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. 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. 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.

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