Current approaches to the treatment of well-differentiated thyroid cancer.

The management of well-differentiated thyroid cancer requires a multidisciplinary approach. The majority of patients are diagnosed only after a nodule is palpable. A cytologic evaluation can readily diagnose a papillary thyroid carcinoma but a follicular carcinoma requires determination of capsular or vascular invasion. Surgical considerations in well-differentiated thyroid cancer are frequently complicated by the need to operate on patients with indeterminate nodules. Also, the extent of surgery remains controversial. A total or near-total thyroidectomy has several advantages: (1) radioactive iodine can be used to ablate any residual thyroid tissue or cancer cells; (2) thyroglobulin levels can be used to follow a patient for recurrence; (3) the risk of leaving a focus of carcinoma in the remaining lobe is eliminated.