Surgical management of recurrent thyroid cancer

While well-differentiated thyroid cancer is generally thought to be a treatable cancer with excellent outcomes, some patients suffer from recurrent disease. Risk factors for recurrent disease include primary disease greater than 4 cm, incomplete resection, multiple positive lymph nodes in the central compartment, and lateral neck disease with multiple positive lymph nodes in multiple levels or pathologic extracapsular extension. These factors can help stratify the thyroid cancer population in to low-, medium-, and high-risk patients. Low-risk patients can generally be followed with thyroglogulin levels and routine ultrasounds to the head and neck. High-risk patients are best monitored with stimulated thyroglobulin, ultrasound of the head and neck, and low-dose iodine 131 uptake scans at the 6- to 12-month mark. The treatment of locoregional recurrent thyroid cancer is surgical resection with the overall goal of complete tumor removal while maintaining function and decreasing risks. The use of adjuvant therapy is dependent on the presence / absence of high risk pathologic features.