From these data and data from the literature, our recommended treatment for well-differentiated
cancer is as follows: For papillary
cancer, resection should be adequate to encompass the entire
tumor, which in most cases would be complete lobectomy and possibly isthmusectomy. Prophylactic
neck dissection is of no value; therapeutic modified
neck dissection should be done for stage II disease. Follicular
cancer can be treated by lobectomy (for small lesions) or subtotal
thyroidectomy. Although total or near-total
thyroidectomy may be required in selected patients with large primary
cancers or in those with extensive capsular invasion or extrathyroid extension, the number of cases indicating this is small. There were only a few such patients with large primaries requiring total
thyroidectomy in this study. Total
thyroidectomy is best avoided in most cases, considering the price of
hypoparathyroidism and the lack of significant improvement in survival compared with lesser ablative techniques. Postoperative ablation with
iodine-131 did not improve survival in staged patients with papillary
cancer (the number of patients with follicular
cancer was too small for analysis). Postoperative thyroid suppression by exogenous
thyroid hormone postoperatively appeared to improve survival. Although the data were not adequate for evaluation in follicular
cancer, there seems to be no reason not to use this postoperatively in high-risk patients with either papillary or follicular
cancer.