Health Dictionary
Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Thyroid adenoma surgery
Introduction
Overview
Overview
Thyroid lobectomy or thyroidectomy is recommended for all patients who develop pressure symptoms of thyroid adenoma.
Surgery
Surgery
The minimal surgical procedure is a thyroid lobectomy, removing all thyroid tissue on the side of the lesion.
- Reasonable suspicion of malignancy, with:
- Hard, firm, and potentially fast growing fixed nodule(s)
- Cervical lymphadenopathy
- Ultrasound high-risk lesion classified as category 4c and 5 of thyroid imaging, reporting and data system classification (TI-RADS)
- Fine needle aspiration cytology (FNAC) class suspicious/positive according to Schmid classification or class 4–5 according to Bethesda classification
- FNAC class requiring further investigations according to Schmid classification or FNAC class 3 according to Bethesda classification, in the presence of indicators of malignancy
- Basal calcitonin serum level increase ( >26 pmol/L in women and 60 pmol/L in men)
- Presence of compression symptoms
- Ultrasound lesions with moderate risk according to thyroid imaging, reporting and data system classification (TI-RADS), if the patient does not wish to undergo regular follow-up
- Past exposure to radiation
- Fine needle aspiration cytology class suspicious requiring further investigations according to Schmid classification or class 3 according to Bethesda classification, as an alternative to monitoring at close intervals (even if no other indicators of malignancy are present).
- Thyroid nodules and positive immediate family history for thyroid carcinoma.
- Subclinical or overt hyperthyroidism based on functional autonomy as an alternative to radioiodine therapy, if the latter is contraindicated or not reasonable or refused by the patient.
- For prevention of complications with progressive retrosternal growth (tracheal compression >35%, superior vena cava syndrome).
- For cosmetic reasons with visible goiter.
Contraindications:[1]
- Asymptomatic euthyroid nodular goiter without suspicion of malignancy.
- “Cold” nodule on scintigraphy without further indicators of malignancy or other reasons to operate.
References
References
- ↑ 1.0 1.1 1.2 Bartsch DK, Luster M, Buhr HJ, Lorenz D, Germer CT, Goretzki PE; et al. (2018). “Indications for the Surgical Management of Benign Goiter in Adults”. Dtsch Arztebl Int. 115 (1–02): 1–7. doi:10.3238/arztebl.2018.0001. PMC 5778395. PMID 29345225.
- ↑ 2.0 2.1 Kwak JY, Han KH, Yoon JH, Moon HJ, Son EJ, Park SH; et al. (2011). “Thyroid imaging reporting and data system for US features of nodules: a step in establishing better stratification of cancer risk”. Radiology. 260 (3): 892–9. doi:10.1148/radiol.11110206. PMID 21771959.
- ↑ 3.0 3.1 Cibas ES, Ali SZ, NCI Thyroid FNA State of the Science Conference (2009). “The Bethesda System For Reporting Thyroid Cytopathology”. Am J Clin Pathol. 132 (5): 658–65. doi:10.1309/AJCPPHLWMI3JV4LA. PMID 19846805.
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Roukoz A. Karam, M.D.[2]; Ammu Susheela, M.D. [3]