**2. Short history of thyroidectomy**

During the twelfth and thirteenth century, there were many speculations regarding the role and the function of the thyroid gland and surgeries have been done according to them [2]. Roger Frugardi was first, in 1170, to describe the extirpation of the gland using setons, hot irons and caustic powder [3].

Evolution of thyroidectomy is related to the advances of the technology even though in the nineteenth century this procedure was considered "barbaric horrid butchery" (by S. Gross) [4]. Later on, in 1880, Jules Boeckel of Strasbourg introduced the collar incision to thyroid surgery, and this approach was popularized, later on, by Theodor Kocher.

The thyroidectomy (near or total), as we know it today, began in the 1860s with the help of Billroth [5]. Thyroid surgery was undertaken before the physiology was understood leading to complications, including massive hemorrhage, infection or injuries of the surrounding structures, which were associated with morbidity and mortality rates of about 40% [4].

lobe. With a slow growth, the papillary cancers often spread to the locally lymph nodes. Even it also affects the local lymph nodes, this cancer responds well to the treatment and is rarely fatal. There are several subtypes of papillary cancers, more than 10 histological variants which

Classic (usual) Clear cell Columnar cell Cribriform-morular Diffuse sclerosing

Follicular Macrofollicular

Solid Tall cell Warthin-like

Microcarcinoma (occult, latent, small, microtumor)

Thyroidectomy without Ligatures in Differentiated Thyroid Cancer

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Unlike the papillary form, the follicular cancer is the second most common thyroid cancer, affecting 10% of the persons diagnosed with thyroid cancer. It is more common in patients whose diet is poor in iodine. This type of cancer is characterized by the development of distant metastases, affecting organs such as the lungs and bones. The prognosis of this type of cancer varies depending on the degree of invasiveness. In the traditional classification of follicular thyroid cancer (FTC), there are two groups: minimally invasive and widely invasive [11–13].

This type is also known as oxyphil cell carcinoma. About 3% of thyroid cancers are of this

The risk classification helps to predict the risk of local recurrence and developing metastases and the mortality in patients with DTC. It uses multiple staging systems which are based on a combination of the size of the primary tumor, specific histology, extrathyroidal spread of the

The staging system most often used for thyroid cancer is the **TNM** (**Table 2**) system, which is

type. Most of the authors consider it as a form of follicular cancer [14].

are documented and can be seen in **Table 1** [9, 10].

**Table 1.** Variants of papillary thyroid cancer.

Papillary thyroid cancer Variants

**3.2. Follicular cancer**

**3.3. Hurthle cell cancer**

**4. Risk classification of DTC**

tumor and the age at diagnosis.

based on three key pieces of information:

In 1880, Sandstrom discovered the parathyroid glands but the fact that hypocalcemia was the definitive cause of tetany was not accepted until the twentieth century [6].

Later, in the nineteenth and the beginning of the twentieth centuries, Theodor Kocher practiced a meticulous thyroidectomy being able to report a mortality rate of 1%. He also described the "cachexia strumipriva" in patients following total thyroidectomy. For his contribution to thyroid pathology, Kocher received the Nobel Prize in 1909 [7, 8].

In 1920, the advances in thyroidectomy reached the peak making Halsted to refer to this surgery as a "feat which today can be accomplished by any competent operator without danger of mishap" [1].

Nowadays, thyroid surgery can be performed with a low mortality as well as with low morbidity. In order to obtain such results, surgeon must be aware of the pathophysiology of the thyroid disorders and must know very well the cervical anatomy.
