Surgery

Whether a patient with DTC should undergo total thyroidectomy or thyroid lobectomy is a controversial treatment issue. Proponents of total thyroidectomy for all patients with DTC defend the need based on the following reasons: (i) high incidence of microscopic multifocal disease, (ii) to facilitate radioactive iodine for the detection and treatment of residual disease, (iii) to allow the use of Tg as a marker for recurrent disease, and (iv) possibility of anaplastic transformation of any microscopic foci of carcinoma (65).

Those who propose limited thyroid resection (lobectomy with isthmus resection) argue that without documented benefit of total thyroidectomy in low-risk patients, even the small increased risk of permanent hypoparathyroidism (4% to 9%) and recurrent nerve damage (1% to 8%) is not justifiable and may avoid life-long thyroid hormone replacement (61).

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