Thyroid adenoma surgery: Difference between revisions
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{{CMG}}; {{AE}} {{RAK}}; {{Ammu}} | {{CMG}}; {{AE}} {{RAK}}; {{Ammu}} | ||
==Overview== | ==Overview== | ||
Thyroid [[lobectomy]] or thyroidectomy is recommended for all patients who develop pressure [[symptom]]s of thyroid adenoma. | Thyroid [[lobectomy]] or thyroidectomy is recommended for all patients who develop pressure [[symptom]]s of thyroid [[adenoma]]. | ||
==Surgery== | ==Surgery== | ||
The minimal surgical procedure is a thyroid [[lobectomy]], removing all [[thyroid]] tissue on the side of the lesion. | The minimal surgical procedure is a thyroid [[lobectomy]], removing all [[thyroid]] tissue on the side of the lesion. | ||
===== '''Indications in patients with goiter without nodules:'''<ref name="pmid293452252">{{cite journal| author=Bartsch DK, Luster M, Buhr HJ, Lorenz D, Germer CT, Goretzki PE et al.| title=Indications for the Surgical Management of Benign Goiter in Adults. | journal=Dtsch Arztebl Int | year= 2018 | volume= 115 | issue= 1-02 | pages= 1-7 | pmid=29345225 | doi=10.3238/arztebl.2018.0001 | pmc=5778395 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29345225 }}</ref><ref name="pmid21771959">{{cite journal| author=Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH et al.| title=Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. | journal=Radiology | year= 2011 | volume= 260 | issue= 3 | pages= 892-9 | pmid=21771959 | doi=10.1148/radiol.11110206 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21771959 }} </ref><ref name="pmid19846805">{{cite journal| author=Cibas ES, Ali SZ, NCI Thyroid FNA State of the Science Conference| title=The Bethesda System For Reporting Thyroid Cytopathology. | journal=Am J Clin Pathol | year= 2009 | volume= 132 | issue= 5 | pages= 658-65 | pmid=19846805 | doi=10.1309/AJCPPHLWMI3JV4LA | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19846805 }} </ref> ===== | ===== '''Indications in patients with goiter without nodules:'''<ref name="pmid293452252">{{cite journal| author=Bartsch DK, Luster M, Buhr HJ, Lorenz D, Germer CT, Goretzki PE et al.| title=Indications for the Surgical Management of Benign Goiter in Adults. | journal=Dtsch Arztebl Int | year= 2018 | volume= 115 | issue= 1-02 | pages= 1-7 | pmid=29345225 | doi=10.3238/arztebl.2018.0001 | pmc=5778395 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29345225 }}</ref><ref name="pmid21771959">{{cite journal| author=Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH et al.| title=Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk. | journal=Radiology | year= 2011 | volume= 260 | issue= 3 | pages= 892-9 | pmid=21771959 | doi=10.1148/radiol.11110206 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21771959 }} </ref><ref name="pmid19846805">{{cite journal| author=Cibas ES, Ali SZ, NCI Thyroid FNA State of the Science Conference| title=The Bethesda System For Reporting Thyroid Cytopathology. | journal=Am J Clin Pathol | year= 2009 | volume= 132 | issue= 5 | pages= 658-65 | pmid=19846805 | doi=10.1309/AJCPPHLWMI3JV4LA | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19846805 }} </ref> ===== | ||
* Reasonable suspicion of malignancy, with: | * Reasonable suspicion of [[malignancy]], with: | ||
** Hard, firm, and potentially fast growing fixed nodule(s) | ** Hard, firm, and potentially fast growing fixed nodule(s) | ||
** Cervical lymphadenopathy | ** Cervical [[lymphadenopathy]] | ||
** Ultrasound high-risk lesion classified as category 4c and 5 of thyroid imaging, reporting and data system classification (TI-RADS) | ** Ultrasound high-risk lesion classified as category 4c and 5 of thyroid imaging, reporting and data system classification (TI-RADS) | ||
** Fine needle aspiration cytology (FNAC) class suspicious/positive according to Schmid classification or class 4–5 according to Bethesda classification | ** Fine needle aspiration cytology (FNAC) class suspicious/positive according to Schmid [[classification]] or class 4–5 according to Bethesda classification | ||
** FNAC class requiring further investigations according to Schmid classification or FNAC class 3 according to Bethesda classification, in the presence of indicators of malignancy | ** FNAC class requiring further investigations according to Schmid [[classification]] or FNAC class 3 according to Bethesda [[classification]], in the presence of indicators of malignancy | ||
** Basal calcitonin serum level increase ( >26 pmol/L in women and 60 pmol/L in men) | ** Basal [[calcitonin]] serum level increase ( >26 pmol/L in women and 60 pmol/L in men) | ||
* Presence of compression symptoms | * Presence of compression [[symptoms]] | ||
====Indications<ref name="pmid293452252" /><ref name="pmid19846805" /><ref name="pmid21771959" />==== | ====Indications:<ref name="pmid293452252" /><ref name="pmid19846805" /><ref name="pmid21771959" />==== | ||
* Ultrasound lesions with moderate risk according to thyroid imaging, reporting and data system classification (TI-RADS), if the patient does not wish to undergo regular follow-up | * [[Ultrasound]] lesions with moderate risk according to thyroid imaging, reporting and data system [[classification]] (TI-RADS), if the patient does not wish to undergo regular follow-up | ||
* Past exposure to radiation | * Past exposure to radiation | ||
* Fine needle aspiration cytology class suspicious requiring further investigations according to Schmid classification or class 3 according to Bethesda classification, as an alternative to monitoring at close intervals (even if no other indicators of malignancy are present) | * Fine needle aspiration [[cytology]] class suspicious requiring further investigations according to Schmid [[classification]] or class 3 according to Bethesda [[classification]], as an alternative to monitoring at close intervals (even if no other indicators of malignancy are present) | ||
* Thyroid nodules and positive immediate family history for thyroid carcinoma | * Thyroid [[nodules]] and positive immediate family history for [[thyroid carcinoma]]. | ||
* Subclinical or overt hyperthyroidism based on functional autonomy as an alternative to radioiodine therapy, if the latter is contraindicated or not reasonable or refused by the patient | * Subclinical or overt [[hyperthyroidism]] based on functional autonomy as an alternative to [[radioiodine]] therapy, if the latter is contraindicated or not reasonable or refused by the patient. | ||
* For prevention of complications with progressive retrosternal growth (tracheal compression >35%, superior vena cava syndrome) | * For prevention of complications with progressive retrosternal growth (tracheal compression >35%, [[superior vena cava syndrome]]). | ||
* For cosmetic reasons with visible goiter | * For cosmetic reasons with visible goiter. | ||
==== '''Contraindications:<ref name="pmid293452252" />''' ==== | ==== '''Contraindications:<ref name="pmid293452252" />''' ==== | ||
* Asymptomatic euthyroid nodular goiter without suspicion of malignancy | * Asymptomatic [[euthyroid]] nodular [[goiter]] without suspicion of [[malignancy]]. | ||
* “Cold” nodule on scintigraphy without further indicators of malignancy or other reasons to operate | * “Cold” nodule on [[scintigraphy]] without further indicators of [[malignancy]] or other reasons to operate. | ||
* | * | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Roukoz A. Karam, M.D.[2]; Ammu Susheela, M.D. [3]
Overview
Thyroid lobectomy or thyroidectomy is recommended for all patients who develop pressure symptoms of thyroid adenoma.
Surgery
The minimal surgical procedure is a thyroid lobectomy, removing all thyroid tissue on the side of the lesion.
Indications in patients with goiter without nodules:[1][2][3]
- Reasonable suspicion of malignancy, with:
- Hard, firm, and potentially fast growing fixed nodule(s)
- Cervical lymphadenopathy
- Ultrasound high-risk lesion classified as category 4c and 5 of thyroid imaging, reporting and data system classification (TI-RADS)
- Fine needle aspiration cytology (FNAC) class suspicious/positive according to Schmid classification or class 4–5 according to Bethesda classification
- FNAC class requiring further investigations according to Schmid classification or FNAC class 3 according to Bethesda classification, in the presence of indicators of malignancy
- Basal calcitonin serum level increase ( >26 pmol/L in women and 60 pmol/L in men)
- Presence of compression symptoms
Indications:[1][3][2]
- Ultrasound lesions with moderate risk according to thyroid imaging, reporting and data system classification (TI-RADS), if the patient does not wish to undergo regular follow-up
- Past exposure to radiation
- Fine needle aspiration cytology class suspicious requiring further investigations according to Schmid classification or class 3 according to Bethesda classification, as an alternative to monitoring at close intervals (even if no other indicators of malignancy are present)
- Thyroid nodules and positive immediate family history for thyroid carcinoma.
- Subclinical or overt hyperthyroidism based on functional autonomy as an alternative to radioiodine therapy, if the latter is contraindicated or not reasonable or refused by the patient.
- For prevention of complications with progressive retrosternal growth (tracheal compression >35%, superior vena cava syndrome).
- For cosmetic reasons with visible goiter.
Contraindications:[1]
- Asymptomatic euthyroid nodular goiter without suspicion of malignancy.
- “Cold” nodule on scintigraphy without further indicators of malignancy or other reasons to operate.
References
- ↑ 1.0 1.1 1.2 Bartsch DK, Luster M, Buhr HJ, Lorenz D, Germer CT, Goretzki PE; et al. (2018). "Indications for the Surgical Management of Benign Goiter in Adults". Dtsch Arztebl Int. 115 (1–02): 1–7. doi:10.3238/arztebl.2018.0001. PMC 5778395. PMID 29345225.
- ↑ 2.0 2.1 Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH; et al. (2011). "Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk". Radiology. 260 (3): 892–9. doi:10.1148/radiol.11110206. PMID 21771959.
- ↑ 3.0 3.1 Cibas ES, Ali SZ, NCI Thyroid FNA State of the Science Conference (2009). "The Bethesda System For Reporting Thyroid Cytopathology". Am J Clin Pathol. 132 (5): 658–65. doi:10.1309/AJCPPHLWMI3JV4LA. PMID 19846805.