Thyroid Cancer (Thyroid Carcinoma): Surgical Therapy

After the diagnosis of thyroid carcinoma, the following approach should be sought depending on the histologic findings:

Carcinoma type Relative frequency Therapy of choice Prognosis
Papillary thyroid cancer (PTC). 50-60%, increasing trend
  • Tumor <1 cm in diameter, well demarcated) → resection of equilateral thyroid lobe (lobectomy) and lymphadenectomy (extirpation regional lymph nodes).
  • Tumor > 1 cm or poor delineation → total thyroidectomy (thyroidectomy) with lymphadenectomy.
  • Following surgery, radioiodine therapy is performed (see below radiotherapy); L-thyroxine.
 5-year survival rate: 80-90%.
Follicular thyroid carcinoma. 20-30 %
  • Total thyroidectomy (TT) with lymphadenectomy.
  • Following surgery, radioiodine therapy is administered (see below for radiation therapy); L-thyroxine
 5-year survival rate: about 80%.
Medullary thyroid carcinoma (C-cell carcinoma, MTC). approx. 5-10 %
  • Total thyroidectomy (TT) with lymphadenectomy Caution. The tumor is not radiosensitive; if necessary, therapy with tyrosine kinase inhibitors can be performed in advanced stages
 5-year survival rate: 60-70%.
Anaplastic thyroid carcinoma (undifferentiated thyroid carcinoma). 1-5 %
  • External beam radiotherapy (radiotherapy, radiatio; first-line therapy), usually given before surgery, or possibly after (usually combined with chemotherapy)
  • For localized tumor → total thyroidectomy with lymph node extirpation.
 Poor: median survival 6 months

Further notes

  • * Small papillary thyroid carcinomas do not require immediate surgical removal: controlled waiting (“active surveillance” strategy) may be a safe option. The guidelines of the American Thyroid Association recommend such a procedure as an alternative to immediate surgery for tumors with a diameter of less than 1.5 cm and a TSH value in the normal range.A study showed that tumor volume seems to be better suited to detect incipient tumor growth than tumor diameter. In a follow-up examination 29 months after diagnosis (by sonography: hypoechogenic structures with irregular margins, microcalcifications or elongated shapes), eleven patients (3.8%) showed tumor growth of more than 3 mm in diameter. Within two years, 2.5% exceeded this threshold, and within five years, 12.1% did. Tumor enlargement of more than 3 mm was associated with an increase in carcinoma volume of more than 50%. Tumor growth – in terms of tumor diameter – was seen in 27% of patients under 50 years of age, but only in 4.6% of those over 50 years of age. Even tumors with a diameter of 1-1.5 cm did not grow more frequently than small tumors.
  • Patients with localized papillary thyroid carcinoma ≥ 1 cm in size were the first to objectively quantify how many lymph nodes were required for risk assessment: The risk that patients with affected lymph nodes were misdiagnosed as nodal negative was:
    • 53%: if a single lymph node was examined.
    • 10%: if > 6 lymph nodes were examined

    Taking into account the stage and considering a 90% certainty to exclude an overlooked lymph node involvement resulted:

    • T1b disease: 6 lymph nodes.
    • T2 disease: 9 lymph nodes
    • T3 disease: 18 lymph nodes
  • Encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC); patients with noninvasive EFVPTC (= “noninvasive follicular thyroid neoplasm with papillary-like nuclear features” (NIFTP)) have a very low risk of poor outcome, ie. i.e., lobectomy of the thyroid gland (complete removal of one of the two lobes of the thyroid gland) is usually sufficient here.
  • In patients with papillary thyroid carcinoma (PTC), after total thyroidectomy (TT), dissection (removal) of the central lymph nodes (Engl.Completion Lymph Node Dissection, CLND), permanent hypoparathyroidism (parathyroid hypofunction) was significantly more common in the group with TT and CLND than in those with TT without CLND (6.6 percent vs. 2.3 percent).