A patient undergoes hemi-thyroidectomy for a 2 cm follicular neoplasm. Final histology shows a 2.2 cm minimally invasive follicular thyroid carcinoma with capsular invasion only (no vascular invasion). According to ATA 2015 guidelines, the recommended management is:
- A Completion total thyroidectomy followed by radioactive iodine ablation
- B Completion total thyroidectomy without radioactive iodine
- C Observation with surveillance thyroglobulin and imaging without completion thyroidectomy ✓
- D External beam radiotherapy to the neck
Correct answer: C. Observation with surveillance thyroglobulin and imaging without completion thyroidectomy
Explanation
ATA 2015 guidelines classify minimally invasive follicular thyroid carcinoma with capsular invasion only (no vascular invasion) and size 2–4 cm as low risk. Hemithyroidectomy alone is considered adequate treatment; completion thyroidectomy is not routinely required. Prognosis is excellent and radioactive iodine is not indicated for low-risk encapsulated follicular carcinoma. Surveillance with thyroglobulin levels and neck ultrasound is the standard follow-up strategy.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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