Esta página aborda el enfoque terapéutico para pacientes con carcinoma papilar de tiroides confinado a la glándula tiroides, con un tamaño ≤4 cm, sin afectación de ganglios linfáticos regionales ni diseminación a distancia.
Cuando está indicada una intervención quirúrgica adicional tras la resección inicial, el enfoque estructurado implica un procedimiento de conversión dirigido al tejido tiroideo remanente para abordar la malignidad primaria persistente y posibilitar los pasos de manejo subsecuentes. Los criterios de elegibilidad completos, la secuencia y los puntos de decisión se encuentran en el protocolo completo.
DOI: 10.1177/10507256251363120
When resection is performed for patients with thyroid cancer ≤2 cm without gross extra-thyroidal extension (cT1) and without metastases (cN0M0), the initial surgical procedure should be a thyroid lobectomy unless there are bilateral cancers or other indications to remove the contralateral lobe.
For patients with low risk, unilateral thyroid cancer >2 and ≤4 cm (cT2N0M0), thyroid lobectomy may be the preferred initial surgical treatment due to significantly lower risk and side effects.
When thyroid lobectomy is offered as initial treatment, counsel the patient about the possibility of conversion to total thyroidectomy or need for subsequent completion thyroidectomy if higher-risk factors emerge intraoperatively or postoperatively.
Completion thyroidectomy for cancer following initial lobectomy may be considered to address persistent primary malignancy, facilitate RAI administration, and/or enhance follow-up based upon higher estimated risk of recurrence identified postoperatively, accounting for recurrent laryngeal nerve function.
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