Of note, it is critically important for the surgeon to ensure the function of the contralateral recurrent laryngeal nerve in order to minimize the potential need for a tracheostomy.6 Less frequently, thyroid cancers can also involve the trachea, esophagus, and/or larynx. The extent of the disease should determine the potential for a curative resection, and in some
of these cases a multidisciplinary approach with an otolaryngologist and/or thoracic surgeon may be helpful. In such cases of locally advanced papillary thyroid cancer, adjuvant therapy with external beam radiation and in some cases chemotherapy may be indicated. Involvement of cervical lymph nodes in papillary thyroid cancer is frequent, reported to occur Inhibitors,research,lifescience,medical in up to 50% of patients.15 The role of neck dissection at the time of
total thyroidectomy is somewhat controversial, Inhibitors,research,lifescience,medical however, since most of the nodal involvement is microscopic and does not affect overall survival. It is generally agreed upon that a therapeutic neck dissection should be pursued in the setting of well-differentiated thyroid cancer patients with clinically positive lymph nodes, whether in the central or Inhibitors,research,lifescience,medical lateral neck compartments.15 There is little evidence to support routine central or lateral neck dissections in the absence of clinically positive nodes found on pre-op exam and/or imaging. Follicular Thyroid and Hurthle Cell Cancer Patients are typically diagnosed with follicular thyroid and Hurthle Inhibitors,research,lifescience,medical cell cancer following a lobectomy, as these variants are generally not able to be discerned from their benign counterparts on routine FNA biopsy. Completion thyroidectomy is indicated for all patients with invasive follicular thyroid cancer. A subset of patients with minimal capsular invasion may be treated with lobectomy alone, as these variants tend to behave similarly to benign follicular adenomas.16 Completion thyroidectomy Inhibitors,research,lifescience,medical is performed in all patients with Hurthle cell carcinoma. CX-5461 molecular weight prophylactic neck dissection is not done for follicular thyroid cancer, as the rates of lymph node metastasis are typically
less than 10%.16 Therapeutic Resminostat dissections are performed in the setting of biopsy-proven metastasis to either the central or lateral neck. The rate of lymph node involvement in Hurthle cell cancer, however, is considerably higher, and therefore the ATA guidelines suggest that prophylactic central neck dissection be considered in these cases. There is no evidence currently in the literature that such practice extends a benefit in terms of disease-free survival3,16 Medullary Thyroid Cancer Medullary thyroid cancer (MTC) comprises 4% of all thyroid malignancies. The majority of cases are sporadic in nature; approximately 20%–25% represent familiar/hereditary syndromes.17 Diagnosis is commonly made by FNA biopsy with specific staining for the presence of calcitonin in the tissue specimen.