It is the authors' opinion that total or near-total thyroidectomy followed by 131I ablation and thyroid hormone suppression therapy are the recommended extent of surgery and treatment of choice in differentiated thyroid cancer. These recommendations are based on the retrospective data, discussed above, showing that total thyroidectomy plus 131I and TSH suppression reduces disease recurrence and mortality, removes all intrathyroidal cancer, and facilitates the use of 131I scans and thyroglobulin measurements to monitor for recurrence. This recommendation is also supported by the recent decision analyses summarized above. This recommendation comes with the caveat that total thyroidectomy must be performed safely with a low complication rate. With the institution of this appropriate treatment regimen, the prognosis for the majority of our patients with differentiated thyroid cancer is excellent.
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