Extent of Surgery and Following Treatment Depending on The Risk Evaluation of Thyroid Cancer

The experience gained in North-West Center for Endocrinology and Endocrine Surgery (St.Petersburg, Russia), performing about 6000 endocrine surgeries annually, shows that in a significant part of patients presenting with differentiated thyroid cancer, it is possible to perform organ-preserving surgeries and to avoid using radioactive iodine therapy. Such tactic are possible only in the settings of the presence of high-quality preoperational cytological diagnostics, thorough following the preoperative examination protocol (ultrasound examination of the neck area performed by the operating surgeon and by the Head of the clinics, further computed tomography of the chest in all the patients with cytological diagnosis of Bethesda 6, screening of medullary carcinoma using calcitonin blood tests), performing radical resection of the primary tumor with a wide use of preventive central cervical lymph node dissection controlled by intra-operative neuro-monitoring, as well as in the settings of long-term follow-up by the operating surgeons employed in the clinic. Radioactive iodine therapy is an integral phase of therapy for locally advanced tumors and tumors with the presence of distant metastases or high risk of the distant metastatic activity. Making the decision on the necessity of radioactive iodine therapy is possible both based on the evaluation of primary tumor characteristics and the evaluation of blood levels of thyroglobulin and antibodies to thyroglobulin.