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PubMed1993

Role of subtotal thyroidectomy in the management of the follicular neoplasm of the thyroid.

Clinically apparent thyroid nodules affect 4% to 7% of the population in North America. Malignant neoplasms of the thyroid comprise only about 1% of all cancers and are found in only 20% of patients undergoing thyroid surgery for suspected thyroid carcinoma. A follicular neoplasm of the thyroid is the most common histologic finding. During surgery, using frozen-section techniques, it is often difficult to distinguish between a benign and malignant lesion. The diagnosis may be deferred following intraoperative frozen-section examination of tissue or changed on evaluation of embedded tissue. In this series of 1224 thyroidectomies from 1976 to 1990, the pathology data from thyroidectomy surgical specimens submitted to tissue analysis were evaluated. It was found that subtotal thyroidectomy was effective in the management of the follicular neoplasm. This approach significantly reduced the morbidity and complications of patients undergoing thyroidectomy.

Adenocarcinoma↗
PubMed2001

Thyroidectomy induces neurofilament expression in adenohypophyses of rats.

We studied the effect of thyroidectomy on neurofilament expression in adenohypophyses of rats. The question of whether thyroxine (T4) administration can reduce this effect was also investigated. Rats were divided into: 1. Euthyroid controls, 2. Thyroidectomized 20 d (Tx 20 d), 3. Thyroidectomized 20 d with replacement of T4 (Tx 20 d + T4 20 d), 4. Thyroidectomized 40 d (Tx 40 d), 5. Thyroidectomized 40 d with replacement of T4 20 d after surgery (Tx 40 d + T4 20 d). Adenohypophyses were studied by immunohistochemistry and Western blot analysis using antibodies against neurofilament 200 kDa (NF-H) and thyroid-stimulating hormone (TSH). The number of thyrotrophs with immunoreactivity for NF-H was increased in Tx 20 d and Tx 40 d rats, whereas T4 administration protected the effect of thyroidectomy. In the thyroidectomized animals, thyrotrophs showed eccentric nuclei and the cytoplasm was full of NF-H immunoreactivity, whereas in T4 treated rats, the thyrotrophs were similar to control. Western blot analysis showed that NF-H expression increased in rats thyroidectomized for 20 and 40 d. T4 given immediately or 20 d after thyroidectomy caused no changes in NF-H expression. We conclude that thyroidectomy induces NF-H expression in adenohypophyses of rats and administration of T4 decreases this effect.

Animals↗
PubMed1978

Effect of thyroidectomy on the secretory profiles of growth hormone, thyrotropin and corticosterone in the rat.

Changes in pituitary hormone secretions following thyroidectomy were examined in sequentially collected blood samples every 15 min day and night for 7 hr from male rats via cannulae into the right atria. Pulsatile growth hormone secretions were observed every 2.5 or 3.5 hr in normal rats, while thyroidectomy 3 weeks prior to experiments abolished the growth hormone burst. Corticosterone profiles from normal rats showed also episodic patterns which were more often observed in the night experiment. The eisodic secretion of corticosterone seemed to inhibit the subsequent growth hormone burst but not vice versa. The interrelation between integrated concentrations of growth hormone and corticosterone showed a negative correlation although the coefficient was not statistically significant. After thyroidectomy, the basal level of corticosterone decreased and the episodic secretion was blunted. There was no nyctohemeral variation in the plasma thyrotropin level in normal rats but small and slow fluctuations. Thyroidectomy caused about ten-fold elevation in the basal thyrotropin level and, in addition to this, a decrease at 1500 hr and an increase during the night, followed thereafter by a decreasing tendency to 0400 hr. Power spectral analysis revealed smaller components in growth hormone secretion of normal rats, which had periods of 60, 40 and 36 min, besides the hormone burst. The spectral analysis also made it clear that there were small and frequent components (40 or 36 min period) in corticosterone secretion.

Animals↗
PubMed1989

Serum parathyroid hormone concentration measured by highly sensitive assay in post-thyroidectomy hypocalcemia of patients with Graves' disease.

To investigate the role of parathyroid function in transient hypocalcemia after subtotal thyroidectomy for Graves' disease, the serum parathyroid hormone (PTH) concentration and nephrogenous (N) cAMP were measured in 16 patients before and after surgery. Serum PTH was measured with two commercially available kits (PTH-M, PTH-C), PTH-M is a recently developed highly sensitive assay using an antibody recognizing the mid-portion of human PTH and a synthetic 125I-tyr45-human PTH (43-68) as a radioligand. One of the 16 patients had severe clinical tetany and had a markedly lower PTH-M concentration and NcAMP after thyroidectomy. However, no significant change in serum PTH-M, PTH-C and NcAMP were observed in the other patients, although their serum calcium (Ca) concentrations decreased significantly. The Data were analyzed by dividing the patients according to the change in serum Ca or PTH. Serum PTH-M and PTH-C significantly decreased in 4 patients whose serum Ca clearly decreased after surgery. Serum Ca on the first postoperative day was significantly lower in patients whose serum PTH decreased after thyroidectomy than in patients whose serum PTH did not. Furthermore, the serum Ca concentration was significantly correlated with PTH-M, and with NcAMP on the third postoperative day. These data proved that hypofunction of the parathyroid gland is important in transient hypocalcemia after subtotal thyroidectomy for Graves' disease. The pathogenetic mechanism of transient hypocalcemia was discussed in comparison with the data from a patient who had overt parathyroid injury.

Calcium↗
PubMed1995

Retrospective evaluation of subtotal and total thyroidectomy in Graves' disease with and without endocrine ophthalmopathy.

A retrospective analysis was performed in 173 consecutive patients with Graves' disease (GD) with the principal aim of evaluating the influences of subtotal (N = 157) and total (N = 19) thyroidectomy on postoperative recurrence rates, endocrine ophthalmopathy (EO) and thyrotropin receptor antibody (TSH-R-ab) titres. Postoperatively recurrent disease, identified by increased thyroid hormone levels, occurred in 32 patients (20%) who underwent subtotal resection. These recurrences were associated with over-representation of preoperative EO (p < 0.001) as well as high TSH-R-ab levels postoperatively (p < 0.05-0.01). Subtotal and total resections were followed by an aggravation of preoperative EO in nine (16%) and one (6%), and by a development of EO in two and none of the patients, respectively. Persistently elevated TSH-R-ab titers during thyrostatic therapy became close to normalized in seven (32%) and 15 (88%) of the patients undergoing subtotal or total thyroidectomies, respectively, which illustrates a thyroid tissue dependency of the autoantibody production. Among the total material of 173 patients, altogether 75 cases exhibited persistent or progressive EO and/or TSH-R-ab elevation after more than 1 year of preoperative thyrostatic treatment. In this group, recurrent GD or aggravated EO occurred in 23 (39%) of those operated with subtotal resection and in one (6%) of those undergoing total thyroidectomy (p < 0.05). The results thus indicate that EO, particularly at the time of surgery, and prevailing TSH-R-ab titers are associated with an increased risk of recurrent GD and suggest that patients exhibiting these characteristics should benefit from total rather than subtotal thyroidectomy.

Adult↗
PubMed2005

Tisseel and its effects on wound drainage post-thyroidectomy: prospective, randomized, blinded, controlled study.

OBJECTIVE: This randomized, blinded, controlled study examines the effects of fibrin sealant (Tisseel, Laboratoire de production Baxter AG, Vienna, Austria) on wound drainage following thyroidectomy. METHODS: Fifty-six consecutive patients were enrolled in the study. Patients were randomized into Tisseel and non-Tisseel treatment groups. Wound drain output was tallied in 8-hour increments by observers blinded to the treatment groups. RESULTS: Fifty-six patients completed the study. Significant decreases in wound drainage were found in the first 8 hours in the Tisseel group. Eight hours postoperatively, wound output in the Tisseel group was reduced by 44% compared with the non-Tisseel group. A significant decrease in the total drainage over the 64-hour time period of 43% was noted between the treatment and control groups. Post-thyroidectomy wound drainage was reduced and trended to earlier drain removal. No significant changes in the length of hospital stay were noted, nor were postoperative complications encountered in either treatment group. CONCLUSIONS: Fibrin sealants offer a unique opportunity to safely decrease post-thyroidectomy wound drainage. This investigation furthers the evidence that fibrin sealants could safely enable the implementation of drain-free thyroidectomies.

Adult↗
PubMed1989

Effects of thyroidectomy on egg production, molt, and plasma thyroid hormone concentrations of turkey hens.

Turkey hens were thyroidectomized at different ages and phases of their reproductive cycles. Egg production, primary remige molting, and plasma thyroxine (T4) and triiodothyronine (T3) concentrations were monitored during each of three experiments. Thyroidectomy of hens (26 and 30 wk of age) prior to photoinduction of egg production prevented subsequent egg production and molting. Thyroidectomy of adult hens (36 wk of age) early in the egg production cycle caused a gradual termination of egg laying without the occurrence of molting. Thyroidectomy of mature hens (66 wk of age) during the light restriction period prior to their second egg production cycle prevented subsequent egg laying and molting. All successful thyroidectomies reduced plasma T4 and T3 to concentrations below the sensitivity levels of the assays. Feeding 1 ppm T4 to thyroidectomized hens resulted in resumption of normal egg production and molting. These results indicate that the thyroid is essential for the initiation and maintenance of egg production and for molting in turkey hens.

Animals↗
PubMed2000

[Parathyroid function after total or subtotal thyroidectomy].

Postoperative parathyroid function was evaluated in 24 total thyroidectomy and 8 subtotal thyroidectomy patients seen by our department between January 1995 and July 1997. Parathyroid function was assessed by measuring the level of serum intact parathyroid hormon (intact-PTH). Hypoparathyroidism was avoided in 23 patients (95.8%) who received a total thyroidectomy and in 7 patients (87.5%) who received a subtotal thyroidectomy. Supplementary therapy for hypoparathyroidism was not required as long as the blood supply to more than two parathyroid glands was preserved. Half of the patients in this study did not require any postoperative supplementary therapy. Thus, the preservation of more than two parathyroid glands is essential for the prevention of hypoparathyroidism. In cases where the parathyroid glands had been resected, parathyroid gland transplantation were performed. In all cases, supplementary therapy was eventually no longer required. In two cases requiring supplementary therapy, a normal range of parathyroid activity was observed 30 months after surgery. The administration of vitamin D3 may suppress the recovery of parathyroid function in patients recieving parathyroid transplantations.

Biomarkers↗
PubMedDate not supplied

RET germline mutation in codon 791 in a family representing 3 generations from age 5 to age 70 years: should thyroidectomy be performed?

OBJECTIVE: To describe a kindred with a rare RET germline mutation in codon 791 and discuss potential management strategies. METHODS: We present clinical and biochemical data as well as results of mutation analysis in our study subjects and provide an overview of related published reports. RESULTS: Multiple endocrine neoplasia type 2 (MEN 2) is a familial cancer syndrome characterized by the development of medullary thyroid carcinoma (MTC), pheochromocytoma, and parathyroid hyperplasia or adenoma. Germline mutations in RET are responsible for this autosomal dominant syndrome. Familial MTC is a variant of MEN 2A and can be caused by RET mutations in codon 791. Deaths from gene carriers with mutations in these codons have not yet been reported. In general, gene carriers with these RET mutations have late-onset MTC. Because only a few kindreds with this specific mutation have been identified and no long-term follow-up data are available, management of these patients can be a challenge. We illustrate the difficulties with decisions about not only when to perform thyroidectomy in these patients but also whether thyroidectomy should even be considered in such gene carriers with a benign course. Our reported kindred included four carriers with a codon 791 RET germline mutation, one of whom had the rare concomitant occurrence of acromegaly and MEN 2A. The 70-year-old mother had acromegaly and hyperparathyroidism but normal serum calcitonin levels and normal findings on thyroid ultrasound examination. She refused pentagastrin testing and any surgical intervention. The 37-year-old daughter had hypothyroidism, a small thyroid gland, and negative results of pentagastrin stimulation testing of calcitonin. The 18-year-old grandson also had a negative pentagastrin test result and normal thyroid ultrasound findings. The 5-year-old granddaughter had normal results of thyroid ultrasonography. In all patients, we recommended thyroidectomy. CONCLUSION: Prospective studies are needed to clarify which patients with codon 791 RET germline mutation should undergo thyroidectomy.

Acromegaly↗
PubMed1999

Possible effect of calcitonin deficiency on bone mass after subtotal thyroidectomy.

Bone mass is purportedly reduced by an excess of endogenous or exogenous thyroid hormone or perhaps by calcitonin deficiency. Patients who have undergone thyroidectomy could be subject to all of these effects. In the present study we tried to demonstrate, whether lack of calcitonin following thyroidectomy has a significant influence on bone density. We measured thyroid hormone levels, TSH and calcitonin and assessed the bone mass in the hip and lumbar spine of 55 patients (32 f, 23 m), who had undergone a subtotal thyroidectomy between 1938 and 1996 on the reason of a non-toxic goitre. TSH levels were suppressed in 16 patients. Serum concentration of total calcium, intact PTH, osteocalcin were normal in all subjects. The mean fasting calcitonin level was in the patient group 2.09 +/- 0.7 pg/ml and in the control group, age matched healthy volunteers, 2.8 +/- 1.2 pg/ml. However, the serum level of calcitonin was not significantly lower than in the control group. 43 patients had an osteopenia or osteoporosis. The interpretation of the results in this study is hampered by the fact, that in women results may be influenced by involutional osteoporosis. Therefore we focus on the potential for osteoporosis among the 23 men. The results of our study indicates, that there is a significant reduction in bone mass in male after thyroidectomy, no matter whether T4 therapy is given or not, and whether TSH is suppressed or in a normal range.

Adult↗
PubMedDate not supplied

[Total versus subtotal thyroidectomy for multiple node goiter: experience with 350 surgically treated cases].

The surgical treatment of benign thyroid pathology and in particular the multinodular form is controversial. This controversy exists and one must choose either perform conservative surgical therapy such as lobectomy or sub-total thyroidectomy or total thyroidectomy. From January 1985 to July 1999, the Authors observed 534 cases of benign thyroid pathology. Of these 534, 330 were diagnosed with primitive goiter, and 20 with recurrent goiter; 13 cases of the primitive goiter type were found to have microfoci of carcinoma inside the goiter on the definitive histologic exam. There were 275 patients who underwent total thyroidectomy and the remaining 75 cases with ultrasound proven multinodular goiter were treated with lobectomy or sub-total thyroidectomy, depending on the appearance at the time of the operation as well as the macroscopic and microscopic exams of the integrity of the glandular parenchyma performed while in the operating room. The Authors demonstrated that in multinodular goiter there is a high percentage of cases with disease involving the entire gland. Many areas of apparently healthy tissue are found to be microscopically involved with a variable grade of chronic lymphocytic thyroiditis or follicular hyperplasia or even lobular dysplasia with the tendency to form nodules. These signs of disease of this organ tend to recur if not treated.

Goiter, Nodular↗
PubMed1998

[Clinical analysis of hoarseness after thyroidectomy].

The present paper reports 86 cases of hoarseness after thyroidectomy. In 37 cases, glottic paralysis was confirmed. Among them the injury of recurrent laryngeal nerve were 89.91% (33/37). In 33(36 side) cases of recurrent laryngeal nerve paralysis, left injury was 20 and right was 16. Referring to the literature author consider that: 1. the recurrent laryngeal nerve was injured easy by thyroidectomy because that thyroid gland was located closely with recurrent laryngeal nerve in neck; 2. recurrent laryngeal nerve injury after thyroidectomy was related to the character of thyroid gland tumor and times of operations; 3. incidence of superior laryngeal nerve injure in thyroidectomy was rare; 4. following up 16 cases of glottic paralysis, most of all (13/16) hoarseness was improved with the health side vocal cords overcompensation.

Adolescent↗
PubMed2001

Prevention of PONV with dexamethasone in female patients undergoing desflurane anesthesia for thyroidectomy.

BACKGROUND: Desflurane is associated with a higher incidence of 24-h postoperative nausea and vomiting (PONV) as compared with sevoflurane or isoflurane. Dexamethasone 5 mg i.v. is suggested to be the minimum effective dose for prophylaxis of PONV in women undergoing thyroidectomy with isoflurane anesthesia. The objective of this study was to investigate whether a 5 mg dose of dexamethasone could be enough for, or a larger dose at 8 mg, could be more capable of preventing PONV in women undergoing desflurane anesthesia for thyroidectomy. METHODS: One hundred and thirty five patients were assigned to receive one of three treatment regimens prior to induction i.e., dexamethasone 8 mg i.v. (Group D8), dexamethesone 5 mg i.v. (Group D5) or saline (Group S). RESULTS: It was demonstrated that the prophylactic administration of either dexamethasone 8 mg or 5 mg significantly reduced the overall incidence of PONV in patients undergoing thyroidectomy with desflurane anesthesia (P < 0.001, Group D8 vs. Group S; Group D5 vs. Group S). However, patients who received dexamethasone 8 mg showed a higher incidence of complete responses (no vomiting or need of rescue antiemetic medication for a 24-h postoperative period) in comparison with those receiving dexamethasone 5 mg (86% vs. 67%; P < 0.01). CONCLUSIONS: The results of this study showed that in PONV prophylaxis, in female patients undergoing desflurane anesthesia for thyroidectomy, the effect of dexamethasone 8 mg was superior to that of dexamethasone 5 mg.

Adult↗
PubMedDate not supplied

Graves-Basedow's disease in children and adolescents: total vs subtotal thyroidectomy.

"Graves' disease" is an autoimmune pathology and is the most important cause of hyperthyroidism in children and adolescents. The treatment for this disease is controversial; there are three different options: synthetic antithyroid drugs, ablation of the thyroid gland with I 131 or surgery. Our study reports the clinical and therapeutic aspects and long-term results of 27 patients (< = 18 years old) treated with total thyroidectomy or "near-total" thyroidectomy from 1975 to August 2001. Antithyroid drugs represent the preliminary treatment of choice. For a long time in the past therapy with radioactive iodine was not recommended; now it represents an efficiently therapy with low morbility. Surgical treatment is suitable when a young patient presents a considerable enlargement of the thyroid gland or when antithyroid medical treatment does not achieve a good control of the disease, or when rapid control of hyperthyroidism is necessary. The surgical treatment can be a total thyroidectomy or a "near-total" thyroidectomy. The first is the best choice for us, because it has a low risk of relapse and a major efficacy in the ophthalmopathy.

Adolescent↗
PubMed2000

Hypocalcemia and hypoparathyroidism after total thyroidectomy: a clinical biological study and surgical considerations.

BACKGROUND: Post-operative hypocalcemia is a common and most often transient event afterextensive thyroid surgery. It may be due to iatrogenic injury to the parathyroid glands. AIMS: We carried out a study aimed to evaluate the incidence of hypocalcemia and hypoparathyroidism following extracapsular total thyroidectomy. METHODS: The study was carried out in 312 patients (273 females and 39 males, whose age was between 23 and 76 years, median age 48.61 +/- 14.1) who had undergone total thyroidectomy (TT) in our department from 1995 to 1998 and in 100 patients (72 females and 28 males, whose age was between 24 and 75 years, median age 51.66 +/- 13.4) who had undergone other (non-thyroid) surgery. RESULTS: Post-operative hypocalcemia was observed in 62 patients of the control group (62%) and the decrease of the serum calcium level lasted about 3 days, and went back to normal within the 5th day. In 2 patients undergoing total thyroidectomy, hypocalcemia was considered severe (confirmed for more than 7 days, symptomatic), these had been operated for large multinodular goitre with mediastinal extension. In these patients the symptoms arose acutely about 5 h after the operation. In both cases the clinical and biological aspects went back to normal within 10 days, after a treatment with calcium and vitamin D. Transient asymptomatic hypocalcemia was observed in 234 thyroidectomized patients (75%) and thus did not need any treatment for it. CONCLUSION: The results obtained confirm that transient hypocalcemia can be observed after any operation; and particularly responsible is the decrease of the calcium concerning the proteins. We found that post-operative hypoparathyroidism is due to injury to the parathyroid glands (parathyroid ischaemia or surgical ablation of one or more glands). Here we see the delayed serum calcium level < or = 7.5 mg/dl or the delayed serum phosphorous level > 7.4 mg/dl. The results of our study, with 2 patients presenting transient post-operative hypoparathyroidism, contribute in confirming that the extracapsular total thyroidectomy aimed to reduce any injury to the parathyroid and to the recurrent nerves, represent the better operation also for the extended benignant thyroidopathies.

Adult↗
PubMed2004

[Morbidity after subtotal and total thyroidectomy in patients with Graves' disease: the basis for decision-making regarding surgical indication and extent of resection].

Compared to radioiodine therapy the surgical treatment of Graves' disease aims to combine high therapeutic efficacy with low morbidity. According to the literature the risk for complications concerning recurrent laryngeal nerve paralysis and hypocalcaemia is lower after subtotal (0.6% and 0.9% respectively) than after total thyroidectomy (1.1% and 1.7% respectively). In contrast, the rate of persistent or recurrent thyrotoxicosis (3.2% and zero respectively) and the rate of worsening or newly developing endocrine ophthalmopathy is higher after subtotal resection than after total thyroidectomy (8% and 2% respectively). On the basis of these data, total thyroidectomy performed by an experienced surgeon is recommended in the case of complicated Graves' disease and in special situations (e.g. pregnancy and breastfeeding, suspected or proven concomitant thyroid malignancy, severe side effects of antithyroid drug treatment). Subtotal thyroidectomy should be reserved for patients with low activity of Graves' goitre, where radioiodine treatment has a similar effect but without the risks associated with surgery.

Graves Disease↗
PubMedDate not supplied

[Non-endoscopic minimally invasive thyroidectomy in papillary carcinoma. Our experience].

INTRODUCTION: Minimal access thyroid surgery, using various techniques, is increasingly being reported. The present study reviews our experience with thyroid surgery using a minimally invasive approach in a group of patients with papillary thyroid carcinoma. METHODS: A total of 15 female patients with a thyroid nodule, not exceeding 2 cm, proven to be a papillary thyroid carcinoma at preoperative evaluation, underwent a total thyroidectomy with non endoscopic minimally invasive approach. RESULTS: None of the patients presented intraoperative central lymphnode involvement. The cytologic preoperative diagnosis was confirmed by histology in all cases. One case of transient recurrent nerve palsy was observed immediately after surgery. No permanent nerve lesions were documented at 4 months. The hospital stay ranged from 48 to 72 hours. The iodine 131 uptake ranged from 0 to 2.13%, similar to that obtained with open thyroidectomy. All patients were satisfied for cosmetic result. CONCLUSIONS: The preliminary results of this study showed that non endoscopic minimally invasive thyroidectomy could be proposed in patients with T1 papillary carcinoma. In our experience the results obtained with this technique are similar to that obtained with open thyroidectomy, with the great advantage of a minimal neck wound and shorter hospital stay. However a higher number of cases and a longer follow-up are needed to confirm the safety of this procedure on the management of papillary cancer of the thyroid.

Adolescent↗
PubMed2006

[Prophylactic thyroidectomy in children who are carriers of a multiple endocrine neoplasia type 2 mutation: description of 20 cases and recommendations based on the literature].

OBJECTIVE: Evaluation of treatment of children who are proven carriers of a multiple endocrine neoplasia type 2 (MEN 2)-associated rearranged during transfection (RET) gene mutation. DESIGN: Retrospective case study and review of the literature. METHOD: Between 1976 and 2005, 6 boys and 14 girls with a proven RET mutation or biochemical indication of MEN 2 had thyroid surgery at the University Medical Center, Groningen, The Netherlands. The median age was 10 years (range: 0-08). Preoperative assessment, surgical procedure, pathological findings, postoperative complications and treatment results were studied and compared with data from the literature. RESULTS: All 20 children underwent total thyroidectomy. In 17 children with preoperatively abnormal basal or stimulated calcitonin levels, total thyroidectomy was combined with tracheo-oesophageal exploration (n = 6) or central compartment dissection (n = 11). C-cell hyperplasia was found in 19 cases (95%) and medullary thyroid carcinoma in 14 (70%; aged 3-18 years). Lymph-node metastases were found in 3 children (15%), all over the age of 10. They underwent additional selective lateral neck dissection, unilateral in 2 cases and bilateral in 1. Two children developed hypoparathyroidism postoperatively, no recurrent laryngeal-nerve palsy was observed. All patients are clinically free of disease after a median follow-up of 9 years (range: 0.6-27). The patients with node metastases still have biochemical evidence of disease. The literature indicates that the progression of the malignant transformation to medullary thyroid carcinoma is connected to the type of RET-mutation. The treatment plan depends on the type of mutation. CONCLUSION: Medullary thyroid cancer occurs at a very young age in carriers ofgermline RET mutations. In patients with high-risk mutations prophylactic thyroidectomy is likely to be recommended before the child reaches the age of 2. Elective central lymph-node dissection can be omitted in this instance. After this age, however, the risk of lymph-node metastases increases and, for cases with increased basal or stimulated calcitonin levels, total thyroidectomy with central compartment dissection is indicated.

Adolescent↗