Operative Approach to Biopsy Diagnostic of Follicular Cell–Derived Malignancy (1)

Recommendation no.ATA guidance
35AFor patients with thyroid cancer greater than 4 cm, or with gross extrathyroidal extension (clinical T4), or clinically apparent metastatic disease to nodes (clinical N1) or distant sites (clinical M1), the initial surgical procedure should include a near-total or total thyroidectomy and gross removal of all primary tumor unless there are contraindications to this procedure. (Strong recommendation, Moderate quality evidence)
35BFor patients with thyroid cancer > 1 cm and < 4 cm without extrathyroidal extension, and without clinical evidence of any lymph node metastases (cN0), the initial surgical procedure can be either a bilateral procedure (near-total or total thyroidectomy) or a unilateral procedure (lobectomy). Thyroid lobectomy alone may be sufficient initial treatment for low risk papillary and follicular carcinomas; however, the treatment team may choose total thyroidectomy to enable radioactive iodine therapy or to enhance follow-up based on disease features and/or patient preferences. (Strong recommendation, Moderate quality evidence)
35CIf surgery is chosen for patients with thyroid cancer < 1 cm without extrathyroidal extension and cN0, the initial surgical procedure should be a thyroid lobectomy unless there are clear indications to remove the contralateral lobe. Thyroid lobectomy alone is sufficient treatment for small, unifocal, intrathyroidal carcinomas in the absence of prior head and neck irradiation, familial thyroid carcinoma, or clinically detectable cervical nodal metastases. (Strong recommendation, Moderate quality evidence)