Should thyroid surgery preserve as much thyroid tissue as possible?

The thyroid gland is a very important gland in the human body. It belongs to the endocrine organ and is located about 2 to 3 cm below the ” Adam’s apple “. The thyroid is shaped like an “H” and is divided into two lateral lobes, the left and right, connected by the isthmus in the middle. Its main function is to synthesize thyroid hormone, which plays an extremely important role in regulating the growth, development and metabolism of the human body, and can affect the functions of various important organs of the human body. Therefore, abnormal thyroid function may spread to the whole body, causing patients to experience abnormal weight, loss of emotional control, and insomnia or lethargy.

In recent years, with more and more patients suffering from thyroid disease, the risk of developing thyroid cancer has increased significantly compared with previous years. When a thyroid nodule appears, there is no need to be overly nervous. First, it is necessary to identify the benign and malignant thyroid nodules. Generally, if a nodule is suspected to be malignant on ultrasonography, the doctor will recommend that the patient undergo a thyroid fine-needle aspiration cytology test. For thyroid nodules with high suspicion of malignancy, local invasion, lymph node metastasis, or benign thyroid nodules with obvious compression symptoms, doctors will recommend surgery as soon as possible.

Before surgery, doctors usually have a preoperative talk with the patient and family to inform the patient about the extent of the thyroidectomy. Many patients, out of fear of surgery or the sequelae of organ removal, will ask doctors to help patients preserve as much thyroid tissue as possible.

So, isn’t the more thyroid tissue preserved, the better? When a patient is diagnosed with thyroid cancer, is it still possible to retain part of the thyroid tissue? From a professional point of view, the above problems require specific analysis of specific problems.

In the case of benign disease, such as nodular goiter, due to concerns about hypothyroidism and surgical complications (such as recurrent laryngeal nerve and parathyroid injury), the traditional domestic approach Excision of obvious nodules, as far as possible to retain normal glandular tissue. For follicular tumors, lobectomy is generally recommended due to the inability to distinguish benign from malignant preoperatively.

For malignant disease, at least ipsilateral gland lobectomy + VI lymph node dissection is required. For risk factors such as metastasis, bilateral lobectomy + central lymph node dissection, or even lateral neck dissection is recommended.

In summary, for benign nodules, the extent of resection requires a balance between resection of the lesion and preservation of thyroid function. For malignant nodules, priority should be given to complete resection of the lesion, the convenience of iodine therapy that may be required, and the reduction of recurrence rates, and only on this basis should thyroid function preservation be considered. Therefore, thyroid surgery is not about keeping as much thyroid tissue as possible, nor is it about removing as much thyroid tissue as possible, but making individualized decisions based on specific circumstances.

Reminder: After thyroid surgery, patients with insufficient thyroxine can take thyroxine tablets to replace them. Therefore, there is basically no need to worry about the loss of thyroid function after surgery. Due to the good prognosis of differentiated thyroid cancer, patients can survive for a long time, but it does not mean that follow-up for 3 or 5 years is enough, and life-long follow-up is required.