ABSTRACT
Differentiated thyroid cancers (DTC) are characterized by indolent behavior, and adequately treated ones have very long-term survival. In last few decades, the incidence of DTC is increasing due to the wide spread use of neck ultrasound and better diagnosis; however, the disease-specific mortality or overall survival for this cancer has remain same. Few of these DTC behave aggressively, and it is important to identify and recognize these subgroups, so that they are aggressively treated. Identification of prognostic factors and staging systems has helped to reduce the proportion of overtreatment in DTC. The extent of surgical resection and lymph node dissection is controversial in early-stage thyroid cancer. Active surveillance and surgery are both valid options for management of early DTC. Hemithyroidectomy and total thyroidectomy (TT) are two accepted approaches for thyroid cancer. TT is complete resection of all visible thyroid tissues including pyramidal lobe and embryological remnants. It ensures resection of occult, multifocal, contralateral lobe disease, facilitates adjuvant radioactive iodine application and use of serum thyroglobulin as a marker during follow-up to detect residual and recurrent disease. Every clinician involved with treatment of thyroid cancer should have critical appraisal of existing available evidence and guidelines and formulate a treatment protocol for individual patients based on staging, prognostic factors with cultural, geographical (iodine deficiency) and resources available locally.
