Question

What is the preferred treatment for a solitary thyroid nodule?

• A. Hemithyroidectomy
• B. Total thyroidectomy
• C. Subtotal thyroidectomy
• D. Enucleation

Hint:

Pick the operation that removes the whole nodule with a margin and also gives a full tissue diagnosis.

Answer 1

The Correct Option is A

Step 1: Understand what a solitary thyroid nodule needs.
A solitary nodule may be benign or malignant, and this usually cannot be settled with complete certainty before surgery even after needle aspiration. So the operation chosen has to both treat the lump and give a clear tissue diagnosis.

Step 2: State the preferred operation.
Hemithyroidectomy, removing the entire lobe carrying the nodule along with the isthmus, is the preferred initial surgery. It removes the whole area of concern with a clear margin and gives the pathologist the full lobe to examine, so the diagnosis is reliable.

Step 3: Explain what happens after histology.
If the final report shows a benign nodule, hemithyroidectomy alone is enough treatment. If it turns out to be a cancer needing more surgery, a completion thyroidectomy can be done as a planned second operation.

Step 4: Check why total thyroidectomy is wrong here.
Removing the whole gland straight away is too aggressive as a first step when the nature of a single nodule is not yet known, and it carries added risk to both parathyroid glands and both recurrent laryngeal nerves for no proven benefit at this stage.

Step 5: Check why subtotal thyroidectomy is wrong here.
Subtotal thyroidectomy, leaving behind a remnant of tissue on both sides, is used for conditions like multinodular goiter or Graves' disease, not for a single well defined nodule, and it would leave abnormal tissue behind on the side of the nodule.

Step 6: Check why enucleation is wrong here.
Simply shelling out the nodule without taking a surrounding margin of normal lobe risks leaving tumor cells behind if it is malignant, and it is not accepted practice for thyroid surgery.

Step 7: Final answer.
Hemithyroidectomy is the preferred treatment for a solitary thyroid nodule.