Differentiated carcinoma of the thyroid: a paradigm shift in surgical approach

Thyroid cancer commonly present with a thyroid nodule, a few with cervical lymphadenopathy or metastases. Total of 1320 patients with differentiated thyroid cancer (DTC) managed in Surgical department, Government General Hospital, Chennai, India for a period of 11 years (1990-2001) were analyzed and 600 patients followed up for a mean of 5.5 years (range, 1-11 years). Aim was to discuss the advantage of ultrasound guided fine needle aspiration cytology (FNAC) in increasing the preoperative pick up of DTC, Papillary microcarcinoma, advantages of total thyroidectomy as the initial operation for DTC and management of thyroid remnant by completion thyroidectomy or radioiodine I 131 ablation. McNemer's test used for estimating efficacy of ultra sound guided (USG) FNAC, Kaplan-meier survival analysis to calculate mortality and Cox's proportional hazards regression analysis for disease free survival were used in the study.