Key Points
4
Treatment Definitions
Extent of Surgery Definitions (ATA Website Definitions)
➤ Total thyroidectomy: Surgical removal of the entire thyroid gland.
➤ Near-total thyroidectomy: Intended extent of resection for thyroid
cancer is total thyroidectomy, but a small remnant may be left for a
specific reason (usually confidence in nerve preservation).
➤ Lobectomy or hemithyroidectomy with or without isthmusectomy:
Surgical removal of one lobe (half) of the thyroid with or without the
isthmus.
➤ Subtotal thyroidectomy: Surgical removal of almost all of the
thyroid gland, leaving 3–5 grams of thyroid tissue with the intent of
maintaining adequate thyroid hormone production. This operation
is not recommended if the diagnosis of thyroid cancer is known
preoperatively.
➤ Completion thyroidectomy: Surgical removal of the remnant
thyroid tissue following procedures of less than total or near-total
thyroidectomy.
Extent of Lymphadenectomy Definitions
➤ Central neck dissection: Central neck lymph nodes include Levels
VI and VII (Figure 3). Central neck dissection is a comprehensive
removal of pretracheal and prelaryngeal lymph nodes, along with at
least one paratracheal nodal basin. It can be unilateral or bilateral;
the laterality and extent of dissection should be documented at
the time of operation in addition to surgical intent (therapeutic vs
prophylactic).
➤ Therapeutic: Implies that metastatic nodal disease is apparent
clinically preoperatively or intraoperatively by examination and/or
imaging, cN1a.
➤ Prophylactic: Implies that no metastatic nodes are detected by
examination or imaging preoperatively or intraoperatively, cN0.
➤ Lateral neck dissection: Full compartment dissection of the lateral
cervical neck lymph nodes in Levels IIA, III, IV, and VB ipsilateral
to the tumor and performed for clinical evidence of metastatic
involvement. Dissection of Levels I, IIB and VA are not regularly
performed but can be considered based on findings suggestive of
metastatic disease in these compartments (Figure 3).
