[First-line surgical treatment of differentiated thyroid cancers]

Differentiated thyroid cancers represent about 90% of all thyroid cancers. Long term prognostic is more often excellent. Surgery is one of the main therapeutic procedures with complementary hormone therapy and radio iodine. Lobectomy with isthmectomy or total thyroidectomy are two different procedures indicated when the disease is limited to the thyroid. The major point of discussion is the morbidity after total thyroidectomy in comparison with subtotal thyroidectomy. If the disease is extended outside thyroid, total thyroidectomy is the "gold standard" associated with lymphadenectomy. It considers central neck compartment with possible extension to the lateral compartments to realise the classical radical neck dissection. Total thyroidectomy allows secondary administration of radio iodine. Prognostic depends more on the cancer himself than the extension of the surgical ressection. The main prognostic element is the age of patient with a limit of 45 to 50 years between the high and low risk. Morbidity of surgery is mainly recurrential palsy and permanent hypoparathyroidism with a rate varying between 1 and 5%. Lymphadenectomy increase these risk with a ratio from 1 to 3 in most series in the literature.