Advantages of total thyroidectomy for management of papillary carcinomas of the thyroid larger than 1.5 cm. include:

A. Possibility of using radioactive iodine postoperatively to identify and treat metastases.

B. The ability to use thyroglobulin levels as a marker for recurrence.

C. Lower overall recurrence rate.

DISCUSSION: Following total thyroidectomy iodine 131 can be used more efficiently because of the absence of normal thyroid tissue, which has greater affinity for iodine than papillary carcinoma tissue. When all normal thyroid tissue is removed, serum thyroglobulin, which is produced by normal and malignant thyroid tissue, becomes a more effective marker for recurrence. The overall recurrence rate is lower for patients undergoing total thyroidectomy, but the risk of hypoparathyroidism is higher for patients who have total thyroidectomy instead of unilateral lobectomy.