The diagnosis of thyroid carcinoma during the postoperative period after less than total thyroidectomy

In clinical practice, small or localized thyroid cancer is often missed at the time of surgery and is diagnosed only later after the pathologist has been able to study multiple sections. Our data suggest that patients with early or localized thyroid cancer can be controlled with less than total thyroidectomy. If the nodule is completely excised without fracture (preferably lobectomy) or not cut into, if there is no evidence of metastatic disease either by palpation or frozen section, and if gross examination of the surgical specimen and frozen sections is negative for carcinoma, it is our policy to place these individuals on a regimen of observation only. Additional surgery is performed only if clinical evidence of recurrent cancer develops. Long-term follow-up of forty-four patients supports this treatment policy. Of these, seven had clinical recurrences: three benign; four (9 per cent) malignant. (The 2 patients with metastatic periglandular lymph nodes in the surgical specimen would not meet our present criteria.) We have in our files several additional patients who seem to support the same conclusions but will be reported on only after longer follow-up.