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Selection of surgical approach for the treatment of bilateral thyroid carcinoma

Yantao Fu, Le Zhou, Daqi Zhang, Xiaoli Liu, Dan Cong, Shijie Li, Hui Sun

This study aims to summarize the clinical features of bilateral thyroid carcinoma as well as to discuss the surgical approaches for its treatment. We analyzed 1999 cases of primary differentiated thyroid carcinoma surgery, of which 556 cases were of bilateral thyroid carcinoma. The age, tumor size, lymph node metastasis of bilateral thyroid cancer was analyzed. Primary bilateral thyroid carcinoma accounted for 27.8% of the cases with a male to female ratio of 1:4.7. Mean age of patients was 42.58 ± 9.07 years. Total or near-total thyroidectomy and routine central lymph node dissection were performed for the treatment of bilateral thyroid carcinoma. Bilateral microcarcinoma accounted for 66.3% of the cases, while the proportion of T1 patients accounted for 88.8%, with a maximum tumor diameter larger than that in unilateral thyroid carcinoma (bilateral 1.01 ± 0.73 cm; unilateral 0.89 ± 0.73 cm; P=0.002). Metastasis rate of central lymph node was significantly higher than that in unilateral thyroid carcinoma (bilateral 214/499, 42.9%; unilateral 370/1195, 31.0%; P<0.01). The metastasis rate in men was higher than that in women, and the central lymph node metastasis rate gradually decreased with increasing age. Observed cases of increased mass volume were accompanied by a significant increase in central and lateral cervical lymph node metastasis rate. Bilateral thyroid carcinoma has been commonly observed mainly in T1 stage tumors, exhibiting higher invasiveness and aggressiveness than unilateral thyroid carcinoma. In these cases, total or near total thyroidectomy is recommended. Surgeons should aim to avoid inducing hypoparathyroidism owing to surgical loss of parathyroid tissue, while protecting the recurrent laryngeal nerve. Prophylactic cervical dissection indications should be broadened for female patients with tumor diameter >1 cm or age <50 years.