The incidence of thyroid cancer has been increasing over the past 30 years. The follicular-cell-derived thyroid carcinomas (DTC) – papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC) – are most common (79 and 13%, respectively). Initial treatment of DTC involves resection of the primary tumour. Post-operative therapy consists of radioactive iodine ablation for most patients, followed by thyroid-stimulating hormone (TSH) suppression with thyroxine. An ongoing controversy in the surgical treatment of DTC is the extent of thyroid gland resection. Consensus guidelines recommend total or near-total thyroidectomy in high-risk DTC (PTC tumour >1–2cm, any tumour, node, metastasis [TNM] stage III and IV [extrathyroidal spread], any N1 [regional metastasis] or M1 [distant metastasis], any patient 㹅 years and <16 years of age, aggressive histological subtypes) rather than thyroid lobectomy as the initial procedure of choice, given its advantages of treating potential multicentric disease, facilitating maximal uptake of adjuvant radioactive iodine and facilitating post-treatment follow-up by monitoring serum thyroglobulin levels and neck ultrasonography. Low-risk patients are currently treated by thyroid lobectomy or total (or near-total) thyroidectomy; in fact, conflicting views persist for low-risk patients who have differentiated thyroid cancer. The main arguments for lobectomy in low-risk PTC patients are that there is no clear evidence that total thyroidectomy may affect the survival of patients with low-risk PTC, and that total thyroidectomy increases the risk of recurrent laryngeal nerve injury and hypoparathyroidism even in the hands of an experienced endocrine surgeon.
