follicular neoplasm

All of the following statements are true about follicular neoplasms except:

a. 20% of follicular neoplasms are cancer.
b. Initially, diagnostic thyroid lobectomy without frozen section is performed.
c. Intraoperative frozen section is misleading.
d. A contralateral nodular disease is an indication for total thyroidectomy.
e. Hashimoto thyroiditis is not an indication for total thyroidectomy.


Answer:
e.

Hashimoto thyroiditis is an indication for total thyroidectomy.

Follicular neoplasm. Approximately 80% of follicular neoplasms or lesions are adenoma
while 20% are cancer. The presence of capsular and/or vascular invasion on permanent histology distinguishes adenomas from follicular cancers.

We generally perform a diagnostic thyroid lobectomy in patients without frozen section. We and others have demonstrated that intraoperative frozen section is misleading and does not provide any additional information >90% of the time. Thus, we wait for permanent histology and if positive for cancer perform a completion thyroidectomy usually within 5 days or after 2 to 3 months from the original thyroid lobectomy. For patients with a follicular neoplasm, we would consider an initial total thyroidectomy for the following: contralateral nodular disease or Hashimoto’s thyroiditis, the patient is already taking thyroid hormone or patient preference.

Reference: Fischer's Mastery of surgery. 6th edition Page 469.