Int J Thyroidol.  2024 May;17(1):30-52. 10.11106/ijt.2024.17.1.30.

Korean Thyroid Association Guidelines on the Management of Differentiated Thyroid Cancers; Part I. Initial Management of Differentiated Thyroid Cancers - Chapter 2. Surgical Management of Thyroid Cancer 2024

• Cho YY
• Lee CR
• Kang HC
• Koo BS
• Kwon H
• Kim SW
• Kim WW
• Kim JH
• Na DG
• Park YJ
• Back K
• Song YS
• Woo SH
• Won HR
• Ryu CH
• Yoon JH
• Lee MK
• Lee EK
• Lee JH
• Lee JY
• Lim DJ
• Lim JY
• Chung YJ
• Jung CK
• Park JO
• Kim HK
• Korean Thyroid Association Guideline Committee on the Managements of Thyroid Nodule and Cancer

• KMID: 2556504
• DOI: http://doi.org/10.11106/ijt.2024.17.1.30

Abstract

The primary objective of initial treatment for thyroid cancer is minimizing treatment-related side effects and unnecessary interventions while improving patients’ overall and disease-specific survival rates, reducing the risk of disease persistence or recurrence, and conducting accurate staging and recurrence risk analysis. Appropriate surgical treatment is the most important requirement for this purpose, and additional treatments including radioactive iodine therapy and thyroid-stimulating hormone suppression therapy are performed depending on the patients’ staging and recurrence risk. Diagnostic surgery may be considered when repeated pathologic tests yield nondiagnostic results (Bethesda category 1) or atypia of unknown significance (Bethesda category 3), depending on clinical risk factors, nodule size, ultrasound findings, and patient preference. If a follicular neoplasm (Bethesda category 4) is diagnosed pathologically, surgery is the preferred option. For suspicious papillary carcinoma (suspicious for malignancy, Bethesda category 5), surgery is considered similar to a diagnosis of malignancy (Bethesda category 6). As for the extent of surgery, if the cancer is ≤1 cm in size and clinically free of extrathyroidal extension (ETE) (cT1a), without evidence of cervical lymph node (LN) metastasis (cN0), and without obvious reason to resect the contralateral lobe, a lobectomy can be performed. If the cancer is 1-2 cm in size, clinically free of ETE (cT1b), and without evidence of cervical LN metastasis (cN0), lobectomy is the preferred option. For patients with clinically evident ETE to major organs (cT4) or with cervical LN metastasis (cN1) or distant metastasis (M1), regardless of the cancer size, total thyroidectomy and complete cancer removal should be performed at the time of initial surgery. Active surveillance may be considered for adult patients diagnosed with low-risk thyroid papillary microcarcinoma. Endoscopic and robotic thyroidectomy may be performed for low-risk differentiated thyroid cancer when indicated, based on patient preference.

Keyword

Thyroid cancer; Thyroidectomy; Guideline; Surgery; Korean Thyroid Association

Figure

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  Fig. I.2.1.A Bethesda 범주에 따른 갑상선결절의 치료 또는 추적검사.

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  Fig. I.2.4.A 경부 림프절 구역(Courtesy of Junsun Ryu, MD).

Reference

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