Thyroid carcinoma: criteria in selection of patients for total and subtotal thyroidectomy

Surgical management of patients with thyroid carcinoma continues to be a controversial subject among surgeons throughout the nation. The authors have recently treated patients with differentiated thyroid carcinoma using a selective surgical approach based on criteria classifying patients into high- and low-risk subgroups. Categorization is based on patient age, size and invasiveness of the tumor, and the presence or absence of distant metastatic disease. Women older than 50 and men over the age of 40 were classified as "high-risk" patients. Other criteria qualifying patients for high-risk categorization included lesion size greater than 3 cm and/or the presence of distant metastases. For patients with follicular tumors, histologic evidence of significant vascular invasion also constituted a high-risk criterion. Patients with high-risk criteria are associated with a significantly poorer prognosis. The records of 136 patients treated from 1958 to 1978 were reviewed. The findings and research from the literature suggest that these high-risk patients, when treated by total thyroidectomy, have an overall increased rate of survival when compared with those under-going lesser surgical procedures.