Behind The Knife: The Surgery Podcast

Operative Standards for Cancer Surgery Series: Papillary Thyroid Cancer

Jan 26, 2026
Guest
David Hughes
Guest
Elizabeth Grubbs
David Hughes, endocrine surgeon focused on papillary thyroid cancer, and Elizabeth Grubbs, surgical oncologist expert in thyroid and other endocrine tumors, discuss operative standards for papillary thyroid carcinoma. They cover choosing lobectomy versus total thyroidectomy, defining low-risk disease, preoperative ultrasound and CT use, anatomy guiding nodal dissection, intraoperative triggers to convert, and balancing parathyroid preservation with extent of surgery.
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ADVICE

Preop Exam Guides Extent Of Surgery

  • Use ultrasound and clinical exam to judge if a PTC is truly low-risk before choosing lobectomy versus total thyroidectomy.
  • Ask about voice change, painful swallowing, and palpate for firmness or lymph nodes to detect possible extrathyroidal invasion.
ADVICE

Always Get A Preoperative Ultrasound

  • Perform a focused ultrasound of the thyroid and lymph node basins before planning surgery.
  • Biopsy suspicious lateral nodes and map central and lateral disease to guide extent of resection.
ADVICE

Use CT For Suspected Posterior Invasion

  • Obtain CT when ultrasound or symptoms suggest tracheal, esophageal, or posterior invasion.
  • Use CT to clarify invasion and nodal extent when ultrasound is limited or patient has hoarseness/firm mass.
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