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The surgical treatment of well-differentiated carcinoma of the thyroid.

Ninety-five surgically treated patients with well-differentiated carcinoma of the thyroid with an average of 11.2 years of follow-up were reviewed. Overall complications included 13% recurrence, 3% deaths due to thyroid cancer, 3% recurrent laryngeal nerve damage, and 2% hypoparathyroidism. Statistically significant prognostic findings included lower rates of recurrence and/or death among patients who were female, without lymph node involvement, or younger than 45. In comparison with total thyroidectomy, subtotal thyroidectomy was associated with markedly higher rates of recurrence and death among Stage II+ patients. No such difference appeared among Stage I patients. No statistically significant differences or meaningful trends could be found in the recurrence or death rates for age, sex, and lymph node status-matched patients treated with total versus subtotal thyroidectomy. These findings suggest the use of age, sex, and staging criteria to decide between subtotal and total thyroidectomy in patients with localized, well-differentiated thyroid cancer. More specifically, females younger than 45 with small tumors and no clinical evidence of nodal involvement or metastases can be treated using subtotal thyroidectomy with some confidence that undue recurrence or death due to cancer will not result. This selective use of subtotal thyroidectomy would avoid the complications of total thyroidectomy, namely, bilateral recurrent laryngeal nerve trauma and hypoparathyroidism, the latter being a particularly troublesome iatrogenic disease.