Questions and Approaches to the Choice of Surgical Treatment of the Differentiated Thyroid Cancer

Abstract

The differentiated thyroid carcinomas (papillary and follicular) are characterized by very favorable prognosis — the survival of patients exceeds 90 %. At the same time, tactics of their treatment is rather aggressive — radical removal of all thyroid gland, often added by a lymph nodes dissection, with the subsequent ablation of residual thyroid tissue. Efficiency of such approach is caused by the good follow-up results: low level of recurrence, long terms of a survival of patients, opportunity to carry out monitoring of patients by thyroglobuline level in blood and in due time to reveal and destroy metastases by radioactive iodine. However, today many surgeons prove possibility of carrying out organ-preserving surgery at the low-invasive differentiated forms of a thyroid cancer. This problem is extremely actually for Ukraine as the incidence of the differentiated thyroid cancer in group of high risk (those who were children and adolescents at the moment of the Chernobyl accident) remains still high. Thus, on the one hand, the fact of radiation exposure in the history of the patient is the accurate indication to a radical thyroidectomy with the subsequent radio iodide ablation. However, on the other hand, with growing-up of patients and moving from the date of the accident, there is increasing the percentage of carcinomas with a low potential of aggressiveness — microcarcinomas and the encapsulated tumors. In this regard carrying out the careful analysis of all cases of «post-Chernobyl» thyroid carcinomas in which organ-preserving surgery was performed, and patients categorically refused from repeated surgical intervention, is very actual. Probably, exactly such researches will make it possible to change reasonably in the future the tactics of surgical treatment of potentially radio-induced thyroid carcinomas.

Keywords

• differentiated thyroid cancer
• papillary carcinoma
• follicular carcinoma