Tx: Primary cannot be assessed.
T0: No evidence of primary.
T1: Limited to thyroid, 2cm or less.
T2:Limited to thyroid>2cm but <4cm.
T3:Limited to thyroid >4cm.
T4:Extending beyond the capsule any size.
T4a: moderately advanced
Nx: Cannot be assessed.
N0: No regional node metastasis.
N1: Regional node metastasis.
N1a: level VI
Mx: Cannot be assessed.
M0: No metastasis.
M1:Metastasis is present.
Stage under 45 yrs
I. Any T, any N,M0
II. Any T, any N,M1
Over 45 yrs
Papillary carcinoma thyroid
• Treatment of primary
-Treatment of choice.
-Entire thyroid gland is removed.
a. Rich intrathyroidal lymphatic spread.
b. Multicentric origin.
• Horizontal anterior neck incision
• Create upper and lower flaps between
the platysma and strap muscles
• Divide vertically between the strap
muscles and anterior jugular veins
• Separate the strap muscles from the
• Divide the middle thyroid vein
• Mobilize the superior pole of the thyroid lobe. Divide
the superior thyroid artery and vein close to the
thyroid gland (avoid injury to the external branch of
the superior laryngeal nerve and the superior
• Identify the recurrent laryngeal nerve whenever
possible using the nerve monitoring device
• Identify the inferior parathyroid artery
• Divide the inferior thyroid artery and vein
• Separate the thyroid lobe and isthmus from the
• Repeat this process for the other thyroid lobe.
Remove the thyroid gland
• Reapproximate the strap muscles
• Reapproximate the platysma muscle
• Close the skin with a subcuticular stitch
1. Easy to detect and treat residual and
2. Eliminates contralteral occult cancer.
3. Eliminates resurgery.
4. Eliminates risk of recurrence, thus improving
After total thyroidectomy, thyroxine is not
given for a period of 4 weeks so that thyroid
remnants can be ablated with radioiodine.
-Removal of one lobe and entire isthumus.
-Total thyroidectomy is recommended for
tumours greater than 2 cm and those with
nodal involvement or metastasis.
-So lobectomy can be done for the remainder.
Advantages of lobectomy:
a. No hormone replacement therapy.
b. No hypoparathyroidism.
c. Need not test thyroid function tests regularly.
• Treatment of secondaries in the lymph
Mostly central neck nodes are cleared. If
nodes are enlarged in the anterior triangle
they are dissected and removed along with fat
and fascia. This is called functional block
Structures such as internal jugular vein,
sternomastoid muscle, accessory nerves are
not removed because lymph nodes are slow
growing and they rarely spread outside the
capsule of the node.
• Suppression of the TSH
This is an aspect in the postoperative period
because papillary carcinoma is a TSH
To prevent the patient developing
hypothyroidism in the post op period and to
suppress TSH, thyroxine 0.3 mg/day is given.
Patients who require regular radioiodine for
scanning and ablation should be given T3
because it acts quickly and can be stopped
and restarted quickly.
On the other hand, T4 has to be stopped
almost 30 days prior to scanning and ablation
rendering patients severely hypothyroid for 4
weeks. Dose:40-60micro gm/day.
• Treatment of primary
When a patient has enlarged thyroid gland
and scalp swelling, total thyroidectomy is the
treatment of choice.
Secondaries donot take up the radioisotope
in the presence of primary tumour. Hence
lobectomy or hemithyroidectomy should not
• Treatment of metastasis
After total thyroidectomy a whole body bone
scan is done to look for metastasis in the
The secondaries can be treated by oral
• Postoperative thyroxine
In the post op period patient should receive
thyroxine 0.3mg/day to suppress TSH and to
• Due to the gross local infiltration into the vital
structures in the neck such as common crotid
artery and trachea, the resectabilty rate is low.
• However rarely isthumus can be excised so as
to relieve compression of the trachea.
• Post operative radiotherapy is given as a
Medullary carcinoma of thyroid
• Total thyroidectomy with radical neck
• The lymph nodes are treated by radical block
dissection because they are fast growing when
compared to papillary carcinoma.
• If there are multiple secondaries in the bone,
oral 131I has no role because this tumour
does not arise from thyroid cells. Only
palliative radiotherapy can be given.