Total thyroidectomy for differentiated thyroid cancer

There has been a long debate about the optimal surgical management of differentiated thyroid cancer. It has focused on the extent of thyroidectomy, with recommendations ranging from thyroid lobectomy to total thyroidectomy. There is no randomized prospective trial addressing this issue; such a trial would be prohibitive, since differentiated thyroid cancer has a good prognosis and a long natural history. Instead, there is heavy reliance on retrospective analyses, as well as consensus expert opinion and experience. We review this evidence, along with recent recommendations from several professional associations. We believe that total or near-total thyroidectomy followed by (131)I ablation and thyroid hormone suppression are most appropriate for the majority of patients with differentiated thyroid cancer, as retrospective analyses have shown that they reduce the risk of cancer recurrence, address the chance of multifocal intrathyroidal cancer, and facilitate use of surveillance scans and thyroglobulin monitoring for post-operative recurrence. This recommendation comes with the caveat that total thyroidectomy must be performed safely, since there is evidence that surgeon volume is associated with patient outcomes.