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Controversies in Thyroid
Nodules and Dierentiated
Thyroid Cancer
ACase-Based Approach
SanzianaA.Roman
WenT.Shen
JulieAnnSosa
Editors
123

Controversies in Thyroid Nodules
and Differentiated Thyroid Cancer

Sanziana A. Roman • Wen T. Shen
https://t.me/medicina_free
Julie Ann Sosa
Editors
Controversies in Thyroid
Nodules and Differentiated
Thyroid Cancer
A Case-Based Approach

Editors
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Sanziana A. Roman
Department of Surgery
University of California, San Francisco
San Francisco, CA, USA
Julie Ann Sosa
Department of Surgery
University of California, San Francisco
San Francisco, CA, USA
Wen T. Shen
Department of Surgery
University of California, San Francisco
San Francisco, CA, USA
ISBN 978-3-031-37134-9 ISBN 978-3-031-37135-6 (eBook)
https://doi.org/10.1007/978-3-031-37135-6
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2023
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microlms or in any other physical way, and
transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specic statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors, and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Paper in this product is recyclable.

Preface
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The evaluation and management of thyroid nodules and differentiated thyroid cancer (DTC) are continually evolving. Despite extensive research and multiple published comprehensive practice guidelines, numerous controversies remain within
this eld covering a wide range of issues, including incidence and epidemiology,
radiographic evaluation, criteria for needle biopsy, cytopathologic and molecular
diagnostics, active surveillance vs. operation for low-risk tumors, extent of surgery,
indications for radioactive iodine treatment and external beam radiation, and optimal protocols for follow-up. In this book, we highlight and explore the most signicant controversies in the diagnosis and treatment of thyroid nodules and DTC and
provide practical, case-based, and evidence-guided recommendations. We feature a
diverse group of authors with expertise spanning the entire spectrum of thyroid care,
representing a wide range of institutions from the USA and abroad. Our goal is to
help guide practitioners of all levels in their care of patients with thyroid nodules
and DTC and to stimulate further inquiry and evidence-based change in knowledge
and practice in this area.
We thank Sabrina Lum for invaluable administrative support, and we express our
gratitude to our colleagues, families, and patients. We dedicate this book to the
memory and legacy of Dr. Orlo H.Clark, a founding gure in the eld of endocrine
surgery and one of the most impactful thought leaders in thyroid research and care.
San Francisco, CA, USA SanzianaA.Roman
San Francisco, CA, USA WenT.Shen
San Francisco, CA, USA JulieAnnSosa
v

Contents
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1 Incidence and Epidemiology of Differentiated Thyroid Cancer: Is
Thyroid Cancer Incidence Truly Increasing, or Is It Simply
a Finder Effect? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Cari M. Kitahara
2 Criteria for Fine Needle Aspiration Biopsy in Thyroid Nodules . . . . 13
Priya H. Dedhia and Jennifer A. Sipos
3 Preoperative Molecular Testing for Indeterminate
Thyroid Nodules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Clifton Davis, Noor Addasi, and Whitney S. Goldner
4 Active Surveillance of Low-Risk Differentiated Thyroid Cancer . . . . 37
Debbie W. Chen and Megan R. Haymart
5 Preoperative Laryngoscopy in Thyroid Surgery Patients . . . . . . . . . . 55
Arvind K. Badhey and David L. Steward
6 Radiofrequency Ablation for Thyroid Nodules . . . . . . . . . . . . . . . . . . 65
Jennifer H. Kuo
7 Management of Low-risk Papillary Thyroid Cancer in
a Patient with Familial Non-Medullary Thyroid Cancer . . . . . . . . . . 79
Wilson Alobuia and Electron Kebebew
8 Intraoperative Nerve Monitoring in Thyroid Operations . . . . . . . . . . 89
Martin Almquist
9 Extent of Surgery for Low-Risk Papillary Thyroid Cancer . . . . . . . . 95
Jessica Dahle and Hadiza S. Kazaure
10 Surgical Management of Locally Advanced Thyroid Cancer
with Tracheal Invasion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Christopher M. K. L. Yao, Maureen V. Hill, and John
A. (Drew) Ridge
vii

viii
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Contents
11 Management of Central Neck Nodes in Papillary
Thyroid Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Iuliana Bobanga and Christopher R. McHenry
12 Impact of Surgeon Volume in Thyroid Operations . . . . . . . . . . . . . . . 131
Fernanda Romero-Hernandez and Mohamed Abdelgadir Adam
13 Intraoperative/Postoperative Calcium Management in
Thyroidectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Mariam Ali-Mucheru and Rebecca S. Sippel
14 Indications for Radioactive Iodine . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Sara H. Duffus and Lindsay A. Bischoff
15 Recurrent Nodal Metastases of Papillary Thyroid Cancer . . . . . . . . . 167
Ray Wang and Julie A. Miller
16 Management of Non-Invasive Follicular Thyroid Neoplasm
with Papillary-like Features (NIFT-P) . . . . . . . . . . . . . . . . . . . . . . . . . 181
May-Anh Nguyen and Jesse D. Pasternak
17 Timing of Long-Term Postoperative Surveillance for Low-Risk
Differentiated Thyroid Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Stephanie Fish
18 External-Beam Radiation for Patients with Differentiated
Thyroid Cancer: Is There a Role? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199
Jelena Lukovic and James D. Brierley
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207

Contributors
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Mohamed Abdelgadir Adam Department of Surgery, University of California
San Francisco, San Francisco, CA, USA
Noor Addasi Department of Internal Medicine, Division of Diabetes,
Endocrinology, and Metabolism, University of Nebraska Medical Center, 984120
Nebraska Medical Center, Omaha, NE, USA
Cotton O’Neil Diabetes and Endocrinology, Stormont Vail Health, Topeka, KS, USA
MariamAli-Mucheru, MD Surgical Specialists of Atlanta, Atlanta, GA, USA
MartinAlmquist Department of Surgery, Lund University, Lund, Sweden
WilsonAlobuia Department of Surgery, Stanford University, Stanford, CA, USA
Arvind K. Badhey Department of Otolaryngology, University of Cincinnati,
Cincinnati, OH, USA
Lindsay A. Bischoff Department of Medicine, Vanderbilt University,
Nashville, TN, USA
Iuliana Bobanga MatSu Surgical Associates, MatSu Regional Medical Center,
Palmer, AK, USA
James D. Brierley Department of Radiation Oncology, University of Toronto,
Toronto, ON, Canada
Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto,
ON, Canada
Debbie W. Chen Department of Medicine, University of Michigan School of
Medicine, Ann Arbor, MI, USA
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Contributors
Jessica Dahle Department of Surgery, Section of Endocrine Surgery, Duke
University Medical Center, Durham, NC, USA
Endocrine and General Surgery, Ochsner Health, New Orleans, LA, USA
Clifton Davis Department of Internal Medicine, Division of Diabetes,
Endocrinology, and Metabolism, University of Nebraska Medical Center, 984120
Nebraska Medical Center, Omaha, NE, USA
Priya H. Dedhia Department of Surgery, The Ohio State University Wexner
Medical Center and Arthur G.James Cancer Center, Columbus, OH, USA
John A. (Drew) Ridge Department of Surgical Oncology, Fox Chase Cancer
Center, Philadelphia, PA, USA
Sara H.Duffus Department of Pediatrics, University of North Carolina Chapel
Hill, Chapel Hill, NC, USA
FernandaRomero-Hernandez Department of Surgery, University of California
San Francisco, San Francisco, CA, USA
StephanieFish Endocrinology Division, Memorial Sloan Kettering Cancer Center,
New York, NY, USA
Whitney S. Goldner Department of Internal Medicine, Division of Diabetes,
Endocrinology, and Metabolism, University of Nebraska Medical Center, 984120
Nebraska Medical Center, Omaha, NE, USA
MeganR. Haymart Department of Medicine, University of Michigan School of
Medicine, Ann Arbor, MI, USA
Maureen V. Hill Department of Surgical Oncology, Fox Chase Cancer Center,
Philadelphia, PA, USA
HadizaS. Kazaure Department of Surgery, Section of Endocrine Surgery, Duke
University Medical Center, Durham, NC, USA
ElectronKebebew Department of Surgery, Stanford University, Stanford, CA, USA
Cari M. Kitahara Radiation Epidemiology Branch, Division of Cancer
Epidemiology and Genetics, National Cancer Institute, National Institutes of Health,
Bethesda, MD, USA
Jennifer H. Kuo Department of Surgery, Columbia University, New York
City, NY, USA
Jelena Lukovic Department of Radiation Oncology, University of Toronto,
Toronto, ON, Canada
Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto,
ON, Canada

Contributors
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xi
ChristopherR.McHenry Case Western Reserve University School of Medicine,
Cleveland, OH, USA
Department of Surgery, MetroHealth Medical Center, Cleveland, OH, USA
Division of General Surgery, MetroHealth Medical Center, Cleveland, OH, USA
Julie A. Miller Department of Endocrine Surgery, Royal Melbourne Hospital,
Parkville, VIC, Australia
May-Anh Nguyen Section of Endocrine Surgery, Division of General Surgery,
University Health Network, University of Toronto, Toronto, ON, Canada
JesseD.Pasternak Section of Endocrine Surgery, Division of General Surgery,
University Health Network, University of Toronto, Toronto, ON, Canada
JenniferA.Sipos Department of Internal Medicine, The Ohio State University
Wexner Medical Center and Arthur G.James Cancer Center, Columbus, OH, USA
RebeccaS.Sippel, MD Department of Surgery, University of Wisconsin-Madison,
Madison, WI, USA
David L. Steward Department of Otolaryngology, University of Cincinnati,
Cincinnati, OH, USA
RayWang Department of Diabetes and Endocrinology, Royal Melbourne Hospital,
Parkville, VIC, Australia
ChristopherM.K.L.Yao Department of Surgical Oncology, Fox Chase Cancer
Center, Philadelphia, PA, USA
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