A 55-year-old man is found to have a 1.8 cm right thyroid nodule with BETHESDA category VI cytology (malignant, consistent with papillary thyroid carcinoma). Preoperative ultrasound shows no lymphadenopathy. The most appropriate surgical management is:

• A Hemithyroidectomy alone, as tumor is <2 cm
• B Total thyroidectomy with prophylactic central neck dissection
• C Total thyroidectomy; central neck dissection only if nodes are palpable ✓
• D Active surveillance; defer surgery if asymptomatic

Explanation

For cN0 papillary thyroid carcinoma >1 cm, total thyroidectomy is standard to allow radioiodine ablation and surveillance. Prophylactic central compartment (level VI) dissection in cN0 disease is controversial; while it reduces local recurrence, it does not improve survival and increases parathyroid and recurrent laryngeal nerve morbidity. Most guidelines (ATA) recommend therapeutic central neck dissection only when nodes are clinically or intraoperatively suspicious, not routinely. Hemithyroidectomy alone is adequate only for low-risk tumors ≤1 cm (micro-PTC).

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.