Differentiated thyroid cancer: Lobectomy and radioiodine, a treatment suitable for all cases?

When treating differentiated carcinoma of the thyroid, lobectomy is the min imum surgical requirement, but there is a strong case for ablation of the w hole gland. Controversy centres on the management of the contralateral lobe , which may be ablated by total thyroidectomy, by near total thyroidectomy and ablation of thyroid fragments by I-131, or by I-131 alone. Operative mo rbidity is increased after total thyroidectomy compared with lobectomy. How ever, radioactive I-131 ablation of the contralateral lobe is associated wi th a longer period of hospitalization than if radioactive I-131 is given to ablate residual fragments of thyroid tissue after total thyroidectomy. The use of lobectomy may lead to a higher incidence of patients requiring more than one administration of I-131. The evidence available indicates that ra dioactive I-131 ablation of the contralateral lobe is a safe procedure unle ss tumour deposits within this lobe are large enough to be visualized on an ultrasound scan, when total thyroidectomy becomes mandatory. Clinical tria ls are necessary to test this hypothesis. ((C) 1999 Lippincott Williams & W ilkins).