In the surgical treatment of glandular nodes , the following surgery options are offered:  

– economical resection of the node (with a malignant neoplasm is not used);

– subtotal resection;

– thyroidectomy;

– thyroidectomy with case-fascial excision of the cervical lymph nodes in the presence of metastases .    

Indications for surgery:

– a cytological diagnosis of malignant neoplasm or any follicular neoplasm ;    

– compression by a knot or goiter of surrounding tissues and organs.    

– concomitant thyrotoxicosis ;  

– large goiter (cosmetic considerations).

Indications for thyroidectomy: during histological examination of frozen sections of material obtained by economical resection, hemithyroidectomy with resection of the isthmus or subtotal resection, thyroid cancer was detected .  

The following observations indicate the need for thyroidectomy in patients with a histological diagnosis of thyroid cancer:

– by the time of surgery, in more than 87% of patients, the cancer has time to capture the entire gland or spread to the surrounding tissue;

– 7-10% of patients after palliative surgery have a relapse of cancer with clinical manifestations;

– postoperative examination to detect metastases (scintigraphy with (131) I and determination of thyroglobulin level ) is informative only if the thyroid tissue is completely removed;  

Determining the scope of the operation:

– if the neoplasm is benign (according to an aspiration biopsy or histological examination of frozen sections obtained during surgery), the affected portion of the gland is removed. If the tumor is located in the isthmus, it is excised with resection of the anterior third of each thyroid lobe;  

– if the neoplasm is malignant , thyroidectomy is indicated. In cases of papillary , papillary-follicular and medullary cancer , gentle excision of the neck tissue is recommended; often the surgeon has to make a final decision during the operation;        

– with undifferentiated cancer, surgery is indicated only at the initial stage of tumor growth; usually use radiation therapy or chemotherapy, or a combination thereof; if the tumor grows rapidly and there is a risk of airway obstruction , a tracheostomy is indicated.    

Complications of thyroidectomy: hypoparathyroidism , damage to the recurrent laryngeal nerve .    

Postoperative management of patients with benign nodes: to prevent relapse of the node or goiter , levothyroxine is prescribed at a dose of 125 mcg / day orally. The correct choice of dose is checked by determining the basal level of TSH (thyroid stimulating hormone) .