...ble to locate them. Also, because of their appearance and size, it may be difficult and at times impossible to differentiate them from paraglandular lymph nodes and fatty tissues short of a microscopic histologic examination. Thus, base on these reasons alone, it is understandable that total thyroidectomy done by even the most skillful thyroid surgeons is associated with a significant incidence of hypoparathyroidism.
Permanent hypoparathyroidism is a crippling complication necessitating life-time medical treatment. With the long life history of the patients with well-differentiated thyroid cancers, permanent hypoparathyroidism is certainly not an acceptable postoperative complication for this group of patients. Thus, because of the high incidence of hypoparathyroidism accompanying total thyroidectomy, this surgical procedure should be done only when there are no other alternatives.
Indications for total thyroidectomy in well-differentiated thyroid carcinomas consist of the following:
1. If the tumor involves the whole or practically the whole gland.
2. If the tumor involves the posterior capsule of both lateral lobes.
3. For tumors, involving the two lateral lobes without involving the posterior capsules of both lobes, a total thyroidectomy is done only if at least one parathyroid gland is definitely identified and can be definitely preserved without difficulty. Otherwise, a near-total thyroidectomy shall be performed preserving the posterior capsule of the lobe with lesser disease.
To recapitulate what has been said regarding treatment of well-differentiated thyroid carcinomas, avoiding specially a complication of hypothyroidism and avoiding