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General Surgery


Answer 1
  1. Total thyroidectomy. In this case, total thyroidectomy is correct because of the size of the lesion. Enucleation should not be performed due to the high risk of nerve injury, hemorrhage, and implantation of cancer in the wound. Lobectomy and isthmusectomy is typically used for small lesions (> 1 cm) and is not an acceptable operation for a 3-cm papillary tumor. In this case, there are no clinically evident lymph nodes necessitating a MRND. MRND can be used to stage large papillary tumors and in patients with palpable cervical lymph nodes, but no data are available regarding the use of bilateral MRND in this setting. Radioiodine ablation may be used in high-risk patients (eg, elderly patients, patients with multiple medical problems) but not in this young, healthy patient.

    SUGGESTED READINGS
    1. Cameron JL, editor. Current surgical therapy. 8th ed. Philadelphia: Elsevier Mosby; 2004.

    2. Townsend CM, Beauchamp RD, Evers BM, et al. Sabiston textbook of surgery: the biological basis of modern surgical practice. 17th ed. Philadelphia: Saunders; 2004.

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