A 40-year-old man undergoes hemithyroidectomy for a 2.5 cm follicular thyroid carcinoma. Final pathology confirms capsular invasion only (no vascular invasion, no extrathyroidal extension). According to ATA 2015 guidelines, what is the most appropriate next step?

• A Completion thyroidectomy + radioiodine ablation
• B No further surgery; observation with TSH-suppressed thyroid hormone ✓
• C Completion thyroidectomy alone without radioiodine
• D External beam radiotherapy to the neck

Explanation

A minimally invasive follicular thyroid carcinoma (capsular invasion only, no vascular invasion, tumor ≤4 cm) is classified as ATA low-risk and does not require completion thyroidectomy after hemithyroidectomy, provided there are no high-risk features. The ATA 2015 guidelines stratify such patients to active surveillance with levothyroxine therapy targeting TSH in the low-normal range, with no mandatory radioiodine. Completion surgery becomes necessary when there is extensive vascular invasion (≥4 foci), large tumor size >4 cm, or gross extrathyroidal extension.

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

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Written and medically reviewed by the StethoPrep medical team.