There is no prospective randomized study with long-term follow-up to guide the surgeon when treating patients with well-differentiated thyroid cancer, and unless a tumor marker with predictive value is discovered, this conundrum will not be settled in the near future. In the absence of a definitive study, I believe that the most logical approach to this tumor is to use risk factor analysis models such as AMES1 or the classifications proposed by Shah et al2 and Shaha et al.3 It is very clear that well-differentiated thyroid cancer can act very differently depending on a patient's risk-factor classification. Low-risk patients tend to do very well regardless of the extent of thyroidectomy, and high-risk patients tend to do poorly even with aggressive treatment. Although papillary thyroid cancer is frequently multifocal, the significance of microscopic disease in the contralateral lobe is questionable. The patient presented in the clinical challenge falls into the low-risk category, and I would favor performing only a thyroid lobectomy under most circumstances. This decision goes hand in hand with the decision not to perform adjuvant radioactive iodine treatment.
Ogren FP. Under Most Circumstances, Thyroid Lobectomy Is Appropriate for Low-Risk Patients With Papillary Cancer of the Thyroid. Arch Otolaryngol Head Neck Surg. 2001;127(4):461–462. doi:10.1001/archotol.127.4.461
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