Thyroid Ultrasound > Nodule Management > Post-Thyroidectomy


The main treatment of papillary carcinoma of the thyroid is surgical resection. 

For lesions <1 cm, there is general agreement in the literature that lobectomy plus isthmectomy is the appropriate treatment. 

For adults with lesions larger than 2 cm, a total thyroidectomy is favored by most surgeons. 

Patients with history of exposure to ionizing radiation of the head and neck should have total thyroidectomy 

Papillary cancer: < 1 cm: Lobectomy & isthmectomy 1-2 cm: debatable >2cm: Total thyroidectomy 

Follicular cancer: Total thyroidectomy 

Hurthle: Total thyroidectomy 

Medullary: Total thyroidectomy & central neck dissection 

Anaplastic: Palliative 

Lymphoma: Chemotherapy 


When surgical management is decided upon, the following steps are taken:

1. Thyroidectomy 

2. TSH goal of 30 if without thyroid hormone replacement, and if on thyroid hormone give 2 days of Thyrogen 

3. Radioiodine uptake scan 

4. I131 treatment: 40-150 mCi range , 60-100 mCi average 

5. Thyroid hormone, average maintenance dose 150 mcg 

6. Serum Thyroglobulin for follow-up 

Postoperative remnant ablation is performed for all patients with differentiated thyroid carcinoma 45 years of age or older, those with primary tumor 1.5 cm in diameter or more, those with extrathyroidal disease, whether manifested by direct invasion through the capsule of the gland or local or regional metastases. 

Radioiodine (131-I) has three uses in the postoperative treatment of patients with thyroid cancer: ablation of residual thyroid tissue, imaging for possible recurrent disease, treatment of residual or recurrent thyroid cancer.

The American Thyroid Association Guidelines Taskforce 2006 (flowcharts directly adapted) 

"Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer" by Cooper DS, et al.

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