We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Commentary |

Arguments for and Against Attempting to Perform a True Total Thyroidectomy for Differentiated Thyroid Cancer

Ralph P. Tufano, MD, MBA1; Gregory W. Randolph, MD2
[+] Author Affiliations
1Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
2Department of Otolaryngology–Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts
JAMA Otolaryngol Head Neck Surg. 2014;140(5):415-416. doi:10.1001/jamaoto.2014.273.
Text Size: A A A
Published online


Holsinger and colleagues1 studied a series of 255 patients with differentiated thyroid cancer (DTC) undergoing total thyroidectomy (TT) and report on the rates of radioactive iodine (RAI) bed uptake and serum thyroglobulin (Tg) positivity subsequent to surgery. Postoperative cervical RAI uptake and Tg positivity after thyroid cancer surgery can be present owing to normal thyroid tissue remnants, which may remain after surgery, as well as persistent malignancy. These initial postoperative data points are used in combination with other more global empirical prognostic schema by our medical endocrine colleagues to determine the initial extent of oncologic treatment such as whether to administer RAI ablation, level of thyroid hormone suppression, and to some degree, the time frame and intensity of subsequent endocrine follow-up. These immediate imaging and biochemical outcome measures of surgery are where surgeons and endocrinologists collaboratively meet in the management of thyroid cancer in patients. This work therefore represents a tremendously important topic in thyroid oncology. These surgical procedures were performed by expert thyroid surgeons at MD Anderson Cancer Center. Iodohippurate sodium I 131 quantitative postoperative imaging revealed insignificant (<0.2%) cervical uptake in 42% of patients, while in 52% of patients there was significant measurable cervical uptake. This uptake was found in the thyroid bed in 83% of patients, in non–thyroid-bed neck regions in 3% of patients, and in both areas in 13% of patients. Interestingly, in patients with negligible cervical RAI uptake, serum Tg positivity was present in 24%, whereas serum Tg positivity was present in 61% of patients with measurable RAI cervical uptake after surgery.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

1 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles