Thyroid Cancer: Extent of Thyroidectomy
Medullary thyroid cancer is an autosomal-dominant familial disease that may present as either a sporadic or familial variety, including the multiple endocrine neo-plasia type 1 (MEN-1) or type 2 (MEN-2) syndrome. Patients with medullary thyroid cancer should undergo total thyroidectomy with appropriate central compartment clearance, including removal of the paratracheal nodes, the tracheoesophageal groove nodes, the nodes around the internal jugular vein, and the superior mediastinal nodes. Lateral neck dissection is generally not indicated unless enlarged lymph nodes are evident in the jugular area. In clinically apparent cervical lymph nodes in patients with medullary thyroid cancer, appropriate neck dissection should be undertaken, which may require the removal of the sternomastoid muscle or jugular vein for proper clearance. Every effort should be made to preserve the accessory nerve if it is not involved directly by the tumor. The appropriate central compartment clearance and total thyroidectomy may result in higher incidence of temporary or permanent hypoparathyroidism in this group of patients. The operating surgeon should be quite familiar with autotransplantation of the parathyroid under these circumstances, especially if the blood supply to the parathyroid gland is damaged.
Medullary thyroid cancer is an autosomal-dominant familial disease that may present as either a sporadic or familial variety, including the multiple endocrine neo-plasia type 1 (MEN-1) or type 2 (MEN-2) syndrome. Patients with medullary thyroid cancer should undergo total thyroidectomy with appropriate central compartment clearance, including removal of the paratracheal nodes, the tracheoesophageal groove nodes, the nodes around the internal jugular vein, and the superior mediastinal nodes. Lateral neck dissection is generally not indicated unless enlarged lymph nodes are evident in the jugular area. In clinically apparent cervical lymph nodes in patients with medullary thyroid cancer, appropriate neck dissection should be undertaken, which may require the removal of the sternomastoid muscle or jugular vein for proper clearance. Every effort should be made to preserve the accessory nerve if it is not involved directly by the tumor. The appropriate central compartment clearance and total thyroidectomy may result in higher incidence of temporary or permanent hypoparathyroidism in this group of patients. The operating surgeon should be quite familiar with autotransplantation of the parathyroid under these circumstances, especially if the blood supply to the parathyroid gland is damaged.