Surgical considerations for thyroid tumours

Thyroid lobectomy
- 25% may require long-term thyroid hormone replacement
- Thyroid replacement may not be available
- TSH/T3/T4 monitoring may be unavailable
Total thyroidectomy
- Transient hypocalcaemia in 5-60%
- Permanent hypocalcaemia in 1.5-5%
- Calcium monitoring and replacement may not be available
- Hypocalcaemia may be fatal
Bilateral RLN injury may be fatal
Central neck dissection increases complication rates (RLN and hypocalcaemia)
Occasional thyroid surgeons have higher hypocalcaemia and RLN complication rates
If RAI unavailable
- Must rely on curative surgical treatment
- May not require total thyroidectomy
Follow-up may be unreliable