10
Treatment
Recommendation 17
A. Initial surgical therapy for thyroid carcinoma arising within a
thyroglossal duct (TGDCa) should include complete tumor/cyst
excision along with the central portion of the hyoid bone (Sistrunk
procedure). (C-L)
B. A Sistrunk procedure and thyroidectomy may be considered for
TGDCa with significant/suspicious thyroid nodularity to ensure
complete resection of possible multicentric disease and/or for
larger tumors, particularly in older patients, to facilitate RAI and/or
enhance follow-up. (C-L)
C. A Sistrunk procedure and total thyroidectomy should be performed
for TGDCa with evidence of more advanced disease (e.g., gross
extension of tumor into surrounding tissues, nodal or distant
metastasis). (S-M)
Recommendation 18
A. Completion (total) thyroidectomy may be considered following
resection of TGDCa with higher-risk factors (similar to completion
thyroidectomy after lobectomy) or that proves to be a metastasis to
the Delphian/prelaryngeal lymph node(s). (C-M)
B. Completion thyroidectomy may be considered following resection
of lower risk TGDCa associated with significant/suspicious thyroid
nodularity to ensure complete resection of possible multicentric
disease, or for larger tumors, particularly in older patients, to
facilitate RAI and/or enhance follow-up. (C-L)
Recommendation 19
A. Prophylactic central-compartment lymph node dissection should not
be performed for most small, non-invasive, clinically node-negative
PTC (cT1-T2, cN0) and for most follicular thyroid carcinomas (FTCs).
(S-M)
B. Prophylactic central-compartment neck dissection may be
considered in patients with PTC and clinically uninvolved lymph
nodes (cN0) who have advanced primary tumors (T3 or T4) or for
whom the information will be used to plan further steps in therapy,
but this approach should be weighed against the risks as they evolve
during thyroidectomy. (C-L)
