Preoperative evaluation

Neck palpation and a comprehensive ultrasonography of all regions of the neck using a high-resolution probe and Doppler technique should be obtained by an experienced ultrasonographer. A complete ultrasonography examination should be performed before surgery.[6,9]

The addition of cross-sectional imaging (contrast-enhanced computed tomography [CT] or magnetic resonance imaging) should be considered when there is concern about invasion of the aerodigestive tract. Importantly, if iodinated contrast agents are used, further evaluation and treatment with radioactive iodine may need to be delayed for 2 to 3 months until total body iodine burden decreases.[9]

Chest imaging (x-ray or CT) may be considered for patients with substantial cervical lymph node disease.[9]

Thyroid nuclear scintigraphy should be pursued only if the patient presents with suppressed thyroid-stimulating hormone (TSH).[9]

The routine use of bone scan or fluorine F 18-fludeoxyglucose positron emission tomography (PET) is not recommended.[9]

Further genetic or imaging diagnostics should be considered in cases of suspected familiar or extensive disease.[6]