In follicular ca of thyroid module , you said we do hemithyroidectomy and send the frozen section to Iook for adenoma vs carcinoma . But sir which lobe to choose for hemithyroidectomy ? How do we know to go for left or right hemithyroidectomy?
In cases of thyroid nodules suspected to be follicular carcinoma, a hemithyroidectomy is often performed as an initial surgical step. The choice between left and right hemithyroidectomy depends on several factors, including the location of the nodule, the surgeon’s expertise, and the patient’s individual circumstances. Here are some considerations for deciding which lobe to choose:
- Dominant Nodule Location: If the follicular nodule is predominantly located in one thyroid lobe, the hemithyroidectomy is typically performed on that side. The lobe containing the nodule is removed, and a frozen section analysis is performed to determine if the nodule is benign (adenoma) or malignant (carcinoma).
- Size and Location: The size and precise location of the nodule within the thyroid lobe can influence the decision. Nodules located more centrally within a lobe might necessitate a larger resection, which could involve a lobectomy (removal of an entire lobe) rather than a smaller hemithyroidectomy.
- Ultrasonography: Ultrasonography can help identify the specific location, size, and characteristics of the nodule. This information aids in planning the surgical approach and choosing the appropriate lobe for resection.
- Surgeon’s Experience: The surgeon’s familiarity with thyroid anatomy and their experience in performing hemithyroidectomies can also play a role in determining which lobe to choose. They will assess the feasibility of the procedure and the potential for complete removal of the nodule.
- Multinodular Thyroid Gland: If the thyroid gland has multiple nodules and only one nodule is suspicious for carcinoma, the surgeon may choose to remove the lobe containing the suspicious nodule, leaving the contralateral lobe intact.
- Patient’s Health and Preference: The patient’s overall health and preferences can influence the surgical approach. Factors such as the patient’s age, medical history, and their desire to preserve thyroid function in the remaining lobe may also guide the decision.
- Pathological Examination: The ultimate decision may also depend on the intraoperative frozen section analysis. If the frozen section indicates malignancy, the surgeon might opt for a completion thyroidectomy (removal of the entire thyroid gland) rather than leaving part of the thyroid in place.
It’s important to note that the decision-making process for hemithyroidectomy is individualized for each patient. Consultation with an experienced endocrine surgeon and a comprehensive evaluation of the patient’s case, including clinical, radiological, and pathological factors, will guide the choice of which lobe to remove.