Management of nodular differentiated thyroid cancer

Mortality and recurrence rate in nodular forms of differentiated thyroid cancer are 10 and 15%, raising the question of whether initial treatment was adequate. Recurrence and mortality appear to be higher after lobectomy than after total thyroidectomy. This could result from the development of dediferentiated relapse or metastasis from residual areas. Metastatic node invasion is frequent (60 to 80%) but does not lead to a high recurrence rate. Prognosis is poor however due to frequent association with visceral metastases. Management should take into account the relative degree of malignancy of this cancer and the risk of mobidity for long surgical procedures. Lobectomy can be acceptable if no criteria of gravity is observed, but total thyroidectomy remains the treatment of choice. In patients with criteria of gravity, needle biopsy guides possible node dissection. Dissection of the recurrent chain misses 20% at the metastatic nodes, while dissection of the supraclavian and middle jugular recurrent chains only misses 7.8%. Radioactive iodine and homone therapy are also indicated in patients with signs of gravity.