Current attitudes in the management of thyroid cancer

The opportunity to assess the current attitudes of surgeons in the management of thyroid cancer was afforded by the responses to a questionnaire that was part of a "Questionnaire Course." The majority of the 72 respondents have a conservative surgical approach to thyroid cancer, find frozen section useful, recommend total thyroidectomy for medullary cancer, seldom or never split the sternum in performing thyroidectomy, and recommend visualization of the recurrent laryngeal nerves and the parathyroids. Opinions however, are divided on several other issues. Forty-two per cent (versus 34%) request ultrasound before removal of a "cold nodule." For follicular carcinoma, 44 per cent perform lobectomy with isthmustectomy, 29 per cent perform total ipsilateral lobectomy and subtotal contralateral lobectomy, and 23 per cent perform total thyroidectomy. Following lobectomy for follicular carcinoma, recommended treatments are radioactive iodine (25%), thyroid suppression (21%), and total thyroidectomy (48%). For anaplastic cancer, 44 per cent perform total thyroidectomy and 40 per cent perform radiation therapy. Histologically positive nodes are managed by modified radical neck dissection (61%) or by "berry picking" (23%). It is concluded that despite agreement on several therapeutic approaches for thyroid cancer, certain controversial issues remain unresolved.