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Treatment Decision Making in Papillary Thyroid Microcarcinoma
Giuseppe Navarra,Guido Nicola Zanghì,Francesco Freni,Bruno Galletti,Francesco Galletti,Grazia Pagano,Andrea Cogliandolo,Alberto Barbera,Salvatore Lazzara,Gianlorenzo Dionigi 대한갑상선-내분비외과학회 2018 The Koreran journal of Endocrine Surgery Vol.18 No.2
The objective of this article is to detail the treatment for papillary thyroid microcarcinoma (PTMC). The literature presents only few contributions, with controversial results, about comparison between ‘active surveillance’ and surgery. Hemithyroidectomy is the treatment of choice for PTMC. Thyroidectomy is indicated in cases of multifocality, extrathyroid tumor growth, and familial PTMCs. Active surveillance can only be done under well-defined and controlled conditions. Collected findings and agreements with the patient must be precisely documented, also for medico-legal reasons. An observation of PTMC seems most appropriate for patients >60 years of age. In the case of observation of a PTMC, a lifelong examination of the tumor disease must be carried out, since tumor growth or metastases can still occur after 10–15 years. The follow-up periods for the ‘active surveillance’ proposed from the literature review are too short to conclude this as a real alternative.
Loss of the Neuromonitoring Signal on the First Side in Planned Total Thyroidectomy
Hoon Yub Kim,Hui Sun,Young Jun Chai,Ralph Tufano,Henning Dralle,Giuseppe Navarra,Gianlorenzo Dionigi 대한갑상선-내분비외과학회 2017 The Koreran journal of Endocrine Surgery Vol.17 No.3
With an increased use of intraoperative neural monitoring (IONM), an adaptation of the resection strategy appears to be necessary in case of an intraoperative loss of signal (LOS) of the first operated side with total thyroidectomy planned. The contralateral side resection with intact recurrent laryngeal nerve (RLN) function from the surgical point of view, basically has 3 options: 1) no contralateral resection in bilateral goiter, Graves disease, or low risk thyroid carcinoma (differentiated and medullary thyroid carcinomas) with the aim of 2-stage completion surgery after recovery of nerve function; 2) contralateral subtotal resection ventrally of the RLN plane in benign goiter with a safety distance to the nerve with the aim of avoiding further surgery; and 3) total thyroidectomy as planned for advanced thyroid carcinomas (including undifferentiated thyroid carcinomas) with the aim of immediate postoperative radioiodotherapy. The following document provides a synopsis of the experiences of the Korean Intraoperative Neural Monitoring Society (KINMoS) for the strategy for planned total thyroidectomy and loss of the neuromonitoring signal on the first thyroid lobe.