ENTtoday
  • Home
  • COVID-19
  • Practice Focus
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Departments
    • Issue Archive
    • TRIO Best Practices
      • Allergy
      • Facial Plastic/Reconstructive
      • Head and Neck
      • Laryngology
      • Otology/Neurotology
      • Pediatric
      • Rhinology
      • Sleep Medicine
    • Career Development
    • Case of the Month
    • Everyday Ethics
    • Health Policy
    • Legal Matters
    • Letter From the Editor
    • Medical Education
    • Online Exclusives
    • Practice Management
    • Resident Focus
    • Rx: Wellness
    • Special Reports
    • Tech Talk
    • Viewpoint
    • What’s Your O.R. Playlist?
  • Literature Reviews
    • Allergy
    • Facial Plastic/Reconstructive
    • Head and Neck
    • Laryngology
    • Otology/Neurotology
    • Pediatric
    • Rhinology
    • Sleep Medicine
  • Events
    • Featured Events
    • TRIO Meetings
  • Contact Us
    • About Us
    • Editorial Board
    • Triological Society
    • Advertising Staff
    • Subscribe
  • Advertise
    • Place an Ad
    • Classifieds
    • Rate Card
  • Search

Changes in the Management of Thyroid Cancer

by Thomas R. Collins • March 10, 2019

  • Tweet
  • Email
Print-Friendly Version

Hemithyroidectomy vs. Total Thyroidectomy

Eric Genden, MD, MHCA, Isidore Friesner Professor and Chair of otolaryngology-head and neck surgery at the Icahn School of Medicine at Mount Sinai in New York, tackled the sometimes difficult question of hemithyroidectomy or total thyroidectomy for well-differentiated stage T2 tumors.

You Might Also Like

  • Management Issues in Recurrent and Metastatic Thyroid Cancer
  • Total or Hemithyroidectomy for Papillary Thyroid Microcarcinoma?
  • Active Surveillance of Papillary Thyroid Cancer Safe, Effective Alternative to Surgery in Some Patients
  • Changes in Thyroid Cancer Incidence Post-2009 ATA Guidelines
Explore This Issue
March 2019

Because of the limitations inherent in assessing the extent of disease, patients should be given full explanations of the nuances at work, Dr. Genden said. “It is important to explain to patients that there are limitations to imaging and pathology in determining the presence of extrathyroidal extension, a contraindication to hemithyroidectomy,” he said. “Understanding these limitations is absolutely critical to shared decision-making.”

Dr. Genden surveyed a variety of practitioners, including 19 endocrinologists, head and neck surgeons, and pathologists regarding their approach to clinical management of patients with T2 disease and he found the responses were “quite disparate.” Pathologists expressed the concern that accuracy rates for ultrasound and CT scans are not great for predicting extrathyroidal extension preoperatively. That’s because, they say, the popular concept that the thyroid gland is well-encapsulated is erroneous. Not uncommonly, pathologists will identify normal thyroid tissue that has escaped through the pseudocapsule and into the surrounding muscle, suggesting that imaging may be misleading. “Extracapsular extension exists in a fair number of benign etiologies,” Dr. Genden said.

Also, he said, ultrasound is limited in its ability to detect peritracheal nodal disease, and those he queried during his informal survey repeatedly emphasized that ultrasound is operator-dependent. He added that nodules in the contralateral lobe were a strong indication to pursue a total thyroidectomy.

Regarding active surveillance, he said “very few endocrinologists were comfortable sitting tight, even with the most benign-looking tumors.”

Also, Hashimoto’s disease, glandular irregularity, and multifocal disease were typically an impetus for total thyroidectomy, particularly for endocrinologists who say the more aggressive procedure makes surveillance easier. Surgeons tend to be split, Dr. Genden said, but added, “Everybody agreed across the board that it’s a multi-disciplinary disease. It requires endocrinology evaluation.”

Dr. Genden also emphasized that in the face of imperfect imaging and limitations regarding pathological confirmation of extrathyroidal extension, patients should be made aware of these limitations to support the shared-decision making process. Dr. Genden said that the “management of T2 thyroid disease remains an imperfect science; it is still an art.”

Loss of Signal

When signal is lost on one side after surgery for thyroid cancer, it is a serious situation, as borne out by statistics, said Gregory Randolph, MD, professor of otolaryngology-head and neck surgery and the Clair and John Bertucci Chair in thyroid surgical oncology at Harvard Medical School in Boston, who helped lead the International Neural Monitoring Study Group’s (INMSG) most recent thyroid guidelines, which looked at incidence of vocal cord paralysis, cost effectiveness of neural monitoring during thyroid surgery, and monitoring methods.

The expected rate of paralysis on the second side should be—all things being equal—about half a percent or one percentage point. But actually, in the world’s literature, the group found, it’s 17%. “It is a high stakes situation once you lose that ipsilateral signal,” Dr. Randolph said.

Pages: 1 2 3 4 | Single Page

Filed Under: Features, Home Slider Tagged With: Clinical Guidelines, thyroid cancer, treatment, Triological Society Combined Sections Meeting 2019Issue: March 2019

You Might Also Like:

  • Management Issues in Recurrent and Metastatic Thyroid Cancer
  • Total or Hemithyroidectomy for Papillary Thyroid Microcarcinoma?
  • Active Surveillance of Papillary Thyroid Cancer Safe, Effective Alternative to Surgery in Some Patients
  • Changes in Thyroid Cancer Incidence Post-2009 ATA Guidelines

The Triological SocietyENTtoday is a publication of The Triological Society.

The Laryngoscope
Ensure you have all the latest research at your fingertips; Subscribe to The Laryngoscope today!

Laryngoscope Investigative Otolaryngology
Open access journal in otolaryngology – head and neck surgery is currently accepting submissions.

Classifieds

View the classified ads »

TRIO Best Practices

View the TRIO Best Practices »

Top Articles for Residents

  • Do Training Programs Give Otolaryngology Residents the Necessary Tools to Do Productive Research?
  • Why More MDs, Medical Residents Are Choosing to Pursue Additional Academic Degrees
  • What Physicians Need to Know about Investing Before Hiring a Financial Advisor
  • Tips to Help You Regain Your Sense of Self
  • Should USMLE Step 1 Change from Numeric Score to Pass/Fail?
  • Popular this Week
  • Most Popular
  • Most Recent
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Vertigo in the Elderly: What Does It Mean?
    • Experts Delve into Treatment Options for Laryngopharyngeal Reflux
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • Weaning Patients Off of PPIs
    • Vertigo in the Elderly: What Does It Mean?
    • New Developments in the Management of Eustachian Tube Dysfunction
    • Some Laryngopharyngeal Reflux Resists PPI Treatment
    • Eustachian Tuboplasty: A Potential New Option for Chronic Tube Dysfunction and Patulous Disease
    • The Dramatic Rise in Tongue Tie and Lip Tie Treatment
    • Podcasts Becoming More Popular Method of Education for Otolaryngologists
    • How to Embrace Optimism in the Midst of the COVID-19 Pandemic
    • Tips on How to Approach Conversations with Patients about the COVID-19 Vaccine
    • Steps You Should Take to Protect Your Voice and Hearing During Telemedicine Sessions
    • Routine Postoperative Adjunct Treatments Unnecessary for Idiopathic Cerebrospinal Fluid Leaks

Polls

Have you spoken with your patients about receiving the COVID-19 vaccine?

View Results

Loading ... Loading ...
  • Polls Archive
  • Home
  • Contact Us
  • Advertise
  • Privacy Policy
  • Terms of Use

Visit: The Triological Society • The Laryngoscope • Laryngoscope Investigative Otolaryngology

Wiley
© 2021 The Triological Society. All Rights Reserved.
ISSN 1559-4939

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.