Question
A 2 cm solitary nodule is present in the left lobe of the thyroid gland. Fine-needle aspiration cytology (FNAC) confirms Papillary Thyroid Carcinoma (PTC). What is the treatment of choice?
| A. |
Hemithyroidectomy (Thyroid Lobectomy)
|
| B. |
Total Thyroidectomy
|
| C. |
Total Thyroidectomy with Radical Neck Dissection
|
| D. |
Radiotherapy
|
Show Answer
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Correct Answer » B
Explanation
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|
Papillary thyroid carcinoma is the most common thyroid malignancy and generally has an excellent prognosis.
Management depends on:
- Tumor size
- Multifocality
- Extrathyroidal extension
- Lymph node involvement
- Distant metastasis
For a papillary carcinoma measuring 2 cm, standard surgical teaching and most examination answers favor:
Total thyroidectomy
Advantages:
- Removes occult multifocal disease (common in papillary carcinoma)
- Facilitates radioactive iodine (RAI) therapy if needed
- Facilitates thyroglobulin monitoring during follow-up
- Reduces recurrence risk
Option Analysis
A. Hemithyroidectomy (Lobectomy)
- Modern guidelines may allow lobectomy for selected low-risk tumors ≤4 cm confined to one lobe without nodal disease.
- However, in traditional surgery MCQs and many postgraduate entrance examinations, a 2 cm papillary carcinoma is treated with total thyroidectomy.
C. Thyroidectomy with Radical Dissection
- Neck dissection is performed only when there is clinically or radiologically proven cervical lymph node metastasis.
- Not indicated routinely.
D. Radiotherapy
- Papillary carcinoma is primarily treated surgically.
- External beam radiotherapy has a limited role.
- Radioactive iodine may be used in selected cases after surgery.
