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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.
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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.

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