World Journal of Surgery

, Volume 24, Issue 8, pp 942–951 | Cite as

Differentiated Thyroid Cancer: “Complete” Rational Approach

  • Electron Kebebew
  • Orlo H. Clark


Controversy continues regarding the optimal management of patients with differentiated thyroid cancer because no prospective randomized studies evaluating the merits of (1) extent of thyroidectomy, (2) postoperative radioactive iodine ablation, or (3) thyroid-stimulating hormone (TSH) suppressive therapy exist. Patients with low risk differentiated thyroid cancer enjoy a relatively good prognosis with a mortality rate of about 2% to 5% and a recurrence rate of about 20%. Despite the excellent prognosis in patients considered to be at low risk, total or near-total thyroidectomy in patients with differentiated thyroid cancer has the advantages that: (1) postoperative radioactive iodine can be used to detect and treat residual normal thyroid tissue and local or distant metastases; (2) follow-up serum thyroglobulin levels are a more sensitive marker of persistent or recurrent disease when all thyroid tissue has been removed; and (3) total or near-total thyroidectomy with postoperative 131I ablation and TSH suppressive therapy is associated with better survival and lower recurrence rates. Patients with occult papillary thyroid cancer and minimally invasive follicular thyroid cancer can be treated by thyroid lobectomy because they have a near-normal life expectancy. Virtually all other patients with differentiated thyroid cancer appear to benefit from more extensive initial treatment.


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Copyright information

© Société Internationale de Chirurgie 2000

Authors and Affiliations

  • Electron Kebebew
    • 1
  • Orlo H. Clark
    • 2
  1. 1.Department of Surgery, School of Medicine, University of California, San Francisco, 513 Parnassus Street, San Francisco, California 94143-0470, USAUS
  2. 2.Department of Surgery, University of California, San Francisco/Mt. Zion Medical Center, 1600 Divisadero Street, San Francisco, California 94143-7921, USAUS

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