Ectopic glands may be intra-thyroidal or located in the thymus, carotid sheath, retroesophageal, anterior mediastinum, or pericardium. Some patients may have supernumerary glands. Superior and inferior glands are usually located within 1 cm from the crossing point of the inferior thyroid artery and the recurrent
laryngeal nerve.24–26 Parathyroid autotransplantation should be performed if the gland’s viability is questionable or the gland has been dissected off the vascular pedicle, especially during a challenging dissection for intracapsular or intra-thyroidal glands. In general, superior glands Inhibitors,research,lifescience,medical are easier to preserve in situ during thyroid cancer surgery, whereas the inferior glands are more often caught up with the tumor or central lymph nodes, selleck products making these glands more difficult to find and Inhibitors,research,lifescience,medical preserve. Of note, frozen section analysis should be done to confirm the parathyroid tissue while ruling out cancer, lymph node, or residual thyroid tissue prior to autotransplantation. Transplantation can be performed into a strap muscle or the sternocleidomastoid muscle by creating a pocket(s) in the muscle and implanting the cold-saline-preserved gland after mincing it into multiple tiny fragments. The pocket can be closed with a permanent Inhibitors,research,lifescience,medical suture or a clip. Implanted gland tissues will induce neovascularization and typically regain function in several weeks.27,28
FOLLOW-UP Postoperative patients can be Inhibitors,research,lifescience,medical followed with annual history and physical exams, serum thyroglobulin (Tg), and US imaging. 131I imaging can be used in the follow-up of high-risk patients or in patients who demonstrate concern for recurrence or potential new disease. The use of radioactive iodine (RAI) ablation treatment in the postoperative management of thyroid cancer patients is somewhat controversial. It is used with the aim of eradicating all remnants of normal thyroid tissue as well as any disease, including potentially involved nodal Inhibitors,research,lifescience,medical beds. In addition, RAI treatment facilitates postoperative screening with serum Tg. The 2009 ATA Guidelines currently recommend the use of RAI postoperatively in patients
with T3, T4, or M1 disease.3 Recent literature suggests that the use of RAI in patients with high-risk variants of papillary thyroid cancer (PTC) can prolong survival.29 AREAS OF CONTROVERSY IN SURGICAL MANAGEMENT Lobectomy versus before Total Thyroidectomy for Papillary Thyroid Microcarcinoma Papillary thyroid carcinoma is the most common subtype of thyroid cancer, generally associated with an excellent overall prognosis.30 A microcarcinoma of the thyroid is defined as a tumor of less than 1 cm, which falls under the classification of T1a by the current American Joint Committee on Cancer. Microcarcinomas account for roughly 40% of all papillary thyroid cancers.31 A recent SEER review found a disease-specific survival for PTC microcarcinoma to be 99.3%.
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