• Rajeev Sharan
• Posted by: Dr Rajeev Sharan

In this video Dr Rajeev Sharan discusses the goals of initial therapy of differentiated thyroid cancer (DTC). He begins by mentioning that the first goal is to remove the primary tumour and the nodal mets, the second being minimising the risk of recurrence and metastatic spread of the disease. Facilitating Radioactive Iodine Ablations (RAI) where appropriate, permitting accurate staging and risk stratification of the disease, and minimising treatment-related morbidity are the other goals of DTC. SEER Data can show that in 5 years, the relative survival rate of patients was over 98%. He mentions that in 2005, certain changes in the ATA guidelines were made for. They now recommend less aggressive surgery for low-risk thyroid cancer Central compartment node excision optional for low-risk thyroid cancer. The guidelines also mention that less than 1 cm cancer, if unifocal, without a radiation history or syndromal PTC only needs lobectomy and no lymph node sampling. Active surveillance could be considered in certain cases. Dr Sharan then elaborates on total thyroidectomy (2:19) and presents a case study on a 55-year-old lady with a 2-year-old hemoptysis. Dr Sharan then introduces the practice of scarless thyroidectomy. Robotic or endoscopic thyroidectomy include the breast axillary approach with CO2 gas, gasless axillary approach and retro-auricular approach which give better cosmetic satisfaction and have been acknowledged as safe as open thyroidectomy. Dr Sharan conclude by saying that the choice of surgical procedure can be tailored to the oncological needs of the patient. Surgical morbidity should be minimal. Remote access robotic or endoscopic thyroidectomy is safe and the ontological outcome is great with better cosmesis.