Thyroid mass.
In addition to the history given in this case the consultants ask for information regarding a family history of thyroid cancer or exposure to irradiation. An FNA is in order all the time (Dr. Fredrickson), only if there is no history of irradiation (Dr. Clark), and repeatedly if the mass is cystic (Dr. Harvey). All concur with thyroid suppression if the FNA and thyroid scan support a benign diagnosis. With an FNA report of a "follicular neoplasm" the consultants state that the pathologist should narrow down the histology further. But coupled with the cold nodule on thyroid scan, a lobectomy is in order. All would proceed with a lobectomy and rely on frozen section before going further. If the mass is malignant on frozen section a completion total thyroidectomy is in order. With a frozen section report of papillary follicular carcinoma all agree that a total thyroidectomy is in order. The management of the lymph nodes varies with removal of the ipsilateral lymph nodes (Dr. Clark), bilateral paratracheal lymph node dissection (Dr. Fredrickson), or a sampling of adjacent lymph nodes including those in the mediastinum (Dr. Harvey). A neck dissection is in order only if some of the lymph nodes are positive for tumor. Two experts (Drs. Clark and Harvey) are never comfortable losing a parathyroid gland. If one is found it should be autotransplanted into the sternocleidomastoid muscle (Dr. Clark) or the brachioradialis (Dr. Harvey). While every attempt should be made to identify and preserve all the parathyroid glands another expert believes that one parathyroid gland is probably enough to sustain normal hormone levels (Dr. Fredrickson).(ABSTRACT TRUNCATED AT 250 WORDS)
Clark
O H
OH
Department of Surgery, Mount Zion Medical Center, University California, San Francisco.
Fredrickson
J M
JM
Harvey
H K
HK
D000236:Adenoma / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D005260:Female; D006801:Humans; D010280:Parathyroid Glands / Q000601:surgery; D011182:Postoperative Care; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000601:surgery*