Esta página aborda a abordagem terapêutica para pacientes com carcinoma papilífero da tireoide confinado à glândula tireoide, medindo ≤4 cm, sem envolvimento de linfonodos regionais e sem disseminação à distância.
Quando intervenção cirúrgica adicional é indicada após a ressecção inicial, a abordagem estruturada envolve um procedimento de conversão direcionado ao tecido tireoidiano remanescente para tratar a malignidade primária persistente e possibilitar as etapas subsequentes de manejo. Os critérios completos de elegibilidade, sequenciamento e pontos de decisão constam no 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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