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KMID : 0371319950480060774
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Journal of the Korean Surgical Society
1995 Volume.48 No. 6 p.774 ~ p.780
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Lymph Node Dissection of the Coexisting Thyroid Carcinoma in Graves' Disease
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황도연
이혁진/전성은/오성수/박윤규
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Abstract
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Coexisting thyroid carcinoma and Graves' disease has been widely reported around the World. The authors present 17 cases in which the diagnosis of thyroid cancer was established pathologically among 251 cases of Graves' disease diagnosed
clinically
at
Presbyterian Medical Center in Chonju, Korea, from January 1980 to June 1993. These cases were analyzed in order to establish guidelines for prophylactic node dissection as part of the initial management of thyroid cancer in patients with Graves'
disease.
@ES This analysis revealed the following:
@EN 1) the average age of the 17 patients was 35.4 years, and the male: female ratio was 1 : 3.3.
2) In 9 of the 17 cases (52.9%) the occult thyroid carcinoma measured less than 1.5 cm.
3) Thedegree of invasiveness manifested in these seventeen cases may be summarized as follows: In Group I(7 cases) there was absence of microscopic capsular invasion and of lymph node metastasis; In Group II(4 cases) there was
microscopiccapsular
invasion but absence of lymph node metastasis; In group III(5 cases) there was either extrathyroidal soft tissue invasion or regional lymph node metastasis; and in Group IV(1 case) there was lymph node invasion and distant metastasis.
4) Fourteen patients underwent either subtotal or near total thyroidoctomy, and three patients underwent total thyroidectomy. Eignt patient underwent some type of neck dissection. As follows: anterior compartment diffection in one of the cases
in
Group
I; functional neck dissection in two cases and jugular node disection in one cases in Group II; and anterior compartmont dissection in one case and modified radical neck dissection in three cases in Group III.
5) The authors propose the following guidelines for prophylactic initial node dissection when a unexpected coexisting thyroid carcinoma is encountered on the frozen section during the surgical management of Graves' disease: Group I cases do not
require
initial neck dissection. In Group II, anterior compartment dissection is sufficient. In Group III, either jugular node distherapy. Group IV requires Ra 131I therapy with or without modified radical neck dissection de pending in the patient's
condition.
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