Follicular Lesion Thyroid - Forum

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Old surgeon

Follicular Lesion Thyroid - Ärzteforum

Post#1 »

A question for the group regarding Intra-operative treatment of a thyroid mass. I recall that this has been discussed but I do not have the posts.

Case: 50 yo female 1.5 cm rt. thyroid lobe mass. FNA inconclusive X2. At surgery a solitary 1.5 cm mass felt without capsule involvement. A rt. lobectomy and isthmus was done. Frozen path = follicular neoplasm.

1) What would you do? Would anyone do a total or sub-total at this point?
2) The final path = papillary carcinoma 1.1 cm, no vascular or capsule involvement. Would anyone go back and take the left lobe?
3) If the path was follicular carcinoma 1.5 cm would you go back?

I have reviewed the medline and there seems to be controversy regarding this disease.


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Surgeon

Re: Follicular Lesion Thyroid - Ärzteforum

Post#2 »

I will not do completion thyroidectomy in any of the two situation you have mentioned especially in the presence of present pathology results.

Pathologist

Re: Follicular Lesion Thyroid - Ärzteforum

Post#3 »

I have a similar case but the pt. is less then forty and is follicular. For papillary I would not go back and if follicular and here is great concern I would go back if the lesion is in a man,anyone greater then 39,vascular invasion and over 1 cm.

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Oncologist

Re: Follicular Lesion Thyroid - Ärzteforum

Post#4 »

For the follicular neoplasm, I would not go back to complete the thyroidectomy. No need and no indication. You have done all what needs to be done for this particular patient with papillary carcinoma without vascular invasion. Faced with follicular carcinoma, I tend to be agressive and will go back to remove teh other lobe.

bonjorno

Re: Follicular Lesion Thyroid - Ärzteforum

Post#5 »

I don't think there is a correct answer to this question. A well differentiated thyroid cancer in this age group has an excellent prognosis regardless of whether a total thyroidectomy or a lobectomy is done.

Having said that, I would not reoperate if this were a papillary cancer but I would if it were follicular because the increased risk of distant mets in that situation makes me feel more strongly about the benefits of adjuvant RAI therapy which cannot be given if a lobe is left behind.

My own experience is that even when I feel comfortable not completing a total thyroidectomy, my endocrine colleagues usually insist that I do so. The medical literature (particularly articles written by Mazziferri) paints a much more ominous prognosis for thyroid cancer than the surgical literature.

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A Doctor

Re: Follicular Lesion Thyroid - Ärzteforum

Post#6 »

I agree about the excellent prognosis of differentiated thyroid cancer in a 50 yrs. woman. The problem has been already discussed in this list and once again I would underline the difficult management in follow-up patients with residual lobe. Endocrinologists and Nuclear Medicine collegues strongly advise to not leave uptaking thyroid residual if you want a reliable postop scintigraphy and TG assay. Total thyroidectomy in skilled hands has not significant morbidity rates; however, nobody is perfect, and every surgeon would be happier to perform lobectomy if an equally safe follow-up could be obtained. Until this problem will not be solved, I will continue to sleep better after a completion thyroidectomy.

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Lady Surgeon

Re: Follicular Lesion Thyroid - Ärzteforum

Post#7 »

If you are agreed with the excellent prognosis, I would sleep better without you or any other surgeon however competent medling in the neck.

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Old surgeon

Re: Follicular Lesion Thyroid - Ärzteforum

Post#8 »

It appears surgical treatment of thyroid cancer continues to be controversial. It was actually my partners case. We have a consult from an endocrine "expert" from the Medical College of Virginia that strongly urges return to the OR and completion total thyroidectomy. It seems mostly to facilitate future scanning and I 131 Rx. I personally don't agree as papillary Cancer is not that radio-sensitive. A second "expert" consult recommends no further surgery because a lobe and isthmus resection is appropriate Rx. for a 1.1 cm. papillary cancer. I do not know what the patient has chosen, I'm sure she must be a bit confused.

सर्जन

Re: Follicular Lesion Thyroid - Ärzteforum

Post#9 »

Thyroid follicular carcinoma is almost entirely unifocal.( papillary carcinoma may be multifocal in 20% of cases.) The extent of the tumor pseudocapsular involvement by follicular cells must be determined for separation between low risk and high risk follicular cancers. Minor involvement includes scattered cells in a portion of the tumor pseudocapsule with occasional blood vessel invasion, while major involvement implies extensive breaching of the tumor pseudocapsule, exttensive blood vessel involvement , or thyroid follicular cells outside the tumor pseudocapsule. In minor involvement, there is no alteration of the survival curve from normal population but in major involvement, the mortality rate may be as high as 50 percent.

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الجراح

Re: Follicular Lesion Thyroid - Ärzteforum

Post#10 »

Not to mention surgeons, who are equally confused.

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