Lobectomy for solitary thyroid nodules

ABSTRACT

Published reports show that the incidence of malignancy in the solitary thyroid nodule ranges between 2.7 and 33% and that the majority of these malignancies are differentiated thyroid carcinomas. The implied benefits of excision of the grossly normal opposite lobe when a differentiated thyroid carcinoma is found in the excised solitary nodule are removal of multifocal disease and thyroid ablation if an angioinvasive follicular carcinoma is present, to facilitate later management of metastases with radioactive iodine. However, follow-up studies demonstrate that despite the high incidence of multifocal disease the recurrence and mortality rates after single lobectomy for differentiated thyroid carcinoma presenting as a solitary nodule remain very low, and no advantage in these respects is conferred by total thyroidectomy with its attendant high incidence of complications. Single lobectomy is therefore justifiable as the treatment of choice for primary lesions of differentiated thyroid carcinoma Presenting as a single nodule. The very low incidence of angio-invasive follicular carcinoma in the solitary nodule does not justify the practice of routine frozen section examination of the excised nodule; with its incurring additional anaesthetic and operative time and the cost of the histological service itself. In the rare instance of angio-invasion being shown in the definitive paraffin section, the remaining thyroid tissue can still be ablated by radioactive iodine or surgery