{"id":4495,"date":"2022-01-26T15:38:21","date_gmt":"2022-01-26T20:38:21","guid":{"rendered":"https:\/\/staging.tiro.flywheelsites.com\/recommendations\/atc\/surgical-management\/"},"modified":"2022-08-16T13:17:24","modified_gmt":"2022-08-16T18:17:24","slug":"surgical-management","status":"publish","type":"page","link":"https:\/\/tiro.expert\/es\/recommendations\/atc\/surgical-management\/","title":{"rendered":"Gesti\u00f3n quir\u00fargica"},"content":{"rendered":"\t<style media=\"screen\">\n\t:root { --row-count: 4; }\n\t<\/style>\n<div class=\"clinical-outline-wrap open\">\n\t<div class=\"outline-header\">\n\t\t<p><strong>Surgical Management<\/strong><\/p>\t\t<p>Clinical Outline<\/p>\n\t<\/div>\n\n\t<div id=\"toc\">\n\t\t<div class=\"aod-opener opened\"><\/div>\n\t\t<div class=\"toc-content\"><\/div>\n\t<\/div>\n\n\t<div id=\"edu\" class=\"wp-block-group__inner-container legend\">\n\t\t<div class=\"aod-opener\"><\/div>\n\n\t\t<div class=\"table-wrap aod-content\">\n\t\t\t<div class=\"table-grid\">\n\n\t\t\t\t<div class=\"table-header table-row\">\n\t\t\t\t\t<div class=\"fixed-col\">Educational Clips from TIROxMDS<\/div>\n\n\t\t\t\t\t<div><i class=\"fad fa-chalkboard-teacher fa-fw fa-lg\" title=\"Primers in Thyroidology\"><\/i><\/div>\n\t\t\t\t\t<div><i class=\"fad fa-presentation fa-fw fa-lg\" title=\"Journal Club Presentation\"><\/i><\/div>\n\t\t\t\t\t<div><i class=\"fad fa-comments fa-fw fa-lg\" title=\"Case-based Discussion (inc. roundtables)\"><\/i><\/div>\n\t\t\t\t\t<div><i class=\"fad fa-podium fa-fw fa-lg\" title=\"Grand Rounds Lectureship\"><\/i><\/div>\n\n\t\t\t\t<\/div>\n\n\t\t\t\t\n\t\t\t\t<div class=\"table-row\">\n\n\t\t\t\t\t<div class=\"fixed-col\"><a href=\"\">1. Prognostic Factors for Stage IVa ATC<\/a><\/div>\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"table-row\">\n\n\t\t\t\t\t<div class=\"fixed-col\"><a href=\"\">2. The Role of Surgery<\/a><\/div>\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t<div class=\"table-row\">\n\n\t\t\t\t\t<div class=\"fixed-col\"><a href=\"\">3. Role of Tracheostomy<\/a><\/div>\n\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\n\t\t\t<div id=\"key\" class=\"legend\">\n\t\t\t\t<div>\n\t\t\t\t\t<div>\n\t\t\t\t\t\t<div><i class=\"fad fa-chalkboard-teacher fa-fw fa-lg\"><\/i><\/div>\n\t\t\t\t\t\t<p> = Primers in Thyroidology<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div>\n\t\t\t\t\t\t<div><i class=\"fad fa-presentation fa-fw fa-lg\"><\/i><\/div>\n\t\t\t\t\t\t<p> = Journal Club Presentation<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div>\n\t\t\t\t\t\t<div><i class=\"fad fa-comments fa-fw fa-lg\"><\/i><\/div>\n\t\t\t\t\t\t<p> = Case-based Discussion (inc. roundtables)<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<div>\n\t\t\t\t\t\t<div><i class=\"fad fa-podium fa-fw fa-lg\"><\/i><\/div>\n\t\t\t\t\t\t<p> = Grand Rounds Lectureship<\/p>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\n\t\t<\/div>\n\t<\/div>\n\n\t<div class='outline-tab closer'><i class='fas fa-times'><\/i><\/div>\n\n\t<div id=\"areas-discord\" class=\"legend cloak\">\n\t\t<div class=\"aod-opener\"><\/div>\n\t\t<div class=\"aod-content\"><\/div>\n\t<\/div>\n\t<div class=\"logo-wrap\">\n\t\t<div class=\"widget widget_media_image\"><div class=\"widget-content\"><a href=\"\/\"><img loading=\"lazy\" decoding=\"async\" width=\"250\" height=\"250\" src=\"https:\/\/tiro.expert\/wp-content\/uploads\/2021\/01\/TIRO-monogram-logo@3x-e1610777576269.png\" class=\"image wp-image-1039  attachment-full size-full\" alt=\"TIRO Thyroid International Recommendations Online monogram logo\" style=\"max-width: 100%; height: auto;\" srcset=\"https:\/\/tiro.expert\/wp-content\/uploads\/2021\/01\/TIRO-monogram-logo@3x-e1610777576269.png 250w, https:\/\/tiro.expert\/wp-content\/uploads\/2021\/01\/TIRO-monogram-logo@3x-e1610777576269-150x150.png 150w\" sizes=\"auto, (max-width: 250px) 100vw, 250px\" \/><\/a><\/div><\/div>\t<\/div>\n\t<div class=\"site-nav\">\n\t\t<div class=\"menu-primary-tiro-container\"><ul id=\"menu-primary-tiro\" class=\"menu\"><li id=\"menu-item-3048\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-has-children menu-item-3048\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/\" data-ps2id-api=\"true\">Care Recommendations<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-4432\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-4432\"><a href=\"#\" data-ps2id-api=\"true\">Differentiated Thyroid Cancer<\/a>\n\t<ul class=\"sub-menu\">\n\t\t<li id=\"menu-item-1987\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1987\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/dtc\/initial-evaluation-of-thyroid-nodules\/\" data-ps2id-api=\"true\">Initial Evaluation of Thyroid Nodules<\/a><\/li>\n\t\t<li id=\"menu-item-1986\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1986\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/dtc\/initial-management\/\" data-ps2id-api=\"true\">Initial Management<\/a><\/li>\n\t\t<li id=\"menu-item-1983\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1983\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/dtc\/initial-staging-response-to-therapy\/\" data-ps2id-api=\"true\">Initial Staging &#038; Response to Therapy<\/a><\/li>\n\t\t<li id=\"menu-item-1984\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1984\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/dtc\/systemic-therapy\/\" data-ps2id-api=\"true\">Systemic Therapy<\/a><\/li>\n\t\t<li id=\"menu-item-1985\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1985\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/dtc\/use-of-rai\/\" data-ps2id-api=\"true\">Use of Radioactive Iodine<\/a><\/li>\n\t\t<li id=\"menu-item-1982\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1982\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/dtc\/recurrent-persistent-disease\/\" data-ps2id-api=\"true\">Recurrent &#038; Persistent Disease<\/a><\/li>\n\t<\/ul>\n<\/li>\n\t<li id=\"menu-item-4433\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-4433\"><a href=\"#\" data-ps2id-api=\"true\">Medullary Thyroid Cancer<\/a>\n\t<ul class=\"sub-menu\">\n\t\t<li id=\"menu-item-4465\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4465\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/mtc\/initial-evaluation-of-thyroid-nodules-suspicious-of-mtc\/\" data-ps2id-api=\"true\">Initial Evaluation of Thyroid Nodules Suspicious of MTC<\/a><\/li>\n\t\t<li id=\"menu-item-4467\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4467\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/mtc\/surgical-management\/\" data-ps2id-api=\"true\">Surgical Management<\/a><\/li>\n\t\t<li id=\"menu-item-4862\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4862\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/mtc\/evaluation-of-advanced-disease\/\" data-ps2id-api=\"true\">Evaluation of Advanced Disease<\/a><\/li>\n\t\t<li id=\"menu-item-4466\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4466\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/mtc\/management-of-specific-clinical-scenarios\/\" data-ps2id-api=\"true\">Management of Specific Clinical Scenarios<\/a><\/li>\n\t<\/ul>\n<\/li>\n\t<li id=\"menu-item-4434\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-4434\"><a href=\"#\" data-ps2id-api=\"true\">Anaplastic Thyroid Cancer<\/a>\n\t<ul class=\"sub-menu\">\n\t\t<li id=\"menu-item-4502\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4502\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/atc\/diagnostic-procedures\/\" data-ps2id-api=\"true\">Diagnostic Procedures<\/a><\/li>\n\t\t<li id=\"menu-item-4501\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4501\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/atc\/initial-staging-treatment-planning\/\" data-ps2id-api=\"true\">Initial Staging &#038; Treatment Planning<\/a><\/li>\n\t\t<li id=\"menu-item-4500\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4500\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/atc\/surgical-management\/\" data-ps2id-api=\"true\">Surgical Management<\/a><\/li>\n\t\t<li id=\"menu-item-4499\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4499\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/atc\/systemic-therapy\/\" data-ps2id-api=\"true\">Systemic Therapy<\/a><\/li>\n\t\t<li id=\"menu-item-4498\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4498\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/atc\/end-of-life-care\/\" data-ps2id-api=\"true\">End of Life Care<\/a><\/li>\n\t<\/ul>\n<\/li>\n\t<li id=\"menu-item-29263\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-29263\"><a href=\"#\" data-ps2id-api=\"true\">Analysis Tools<\/a>\n\t<ul class=\"sub-menu\">\n\t\t<li id=\"menu-item-29264\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-29264\"><a href=\"https:\/\/tiro.expert\/es\/ata-2025-risk-of-recurrence-calculator\/\" data-ps2id-api=\"true\">Risk of Recurrence Calculator<\/a><\/li>\n\t\t<li id=\"menu-item-20846\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-20846\"><a href=\"https:\/\/tiro.expert\/es\/recommendations\/analysis-tools\/\" data-ps2id-api=\"true\">Anatomic Checklist for Thyroid Cancer<\/a><\/li>\n\t<\/ul>\n<\/li>\n\t<li id=\"menu-item-1990\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1990\"><a href=\"https:\/\/tiro.expert\/es\/clinical-trial-options\/\" data-ps2id-api=\"true\">Clinical Trial Options<\/a><\/li>\n\t<li id=\"menu-item-3818\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-3818\"><a href=\"https:\/\/tiro.expert\/es\/tables-and-figures\/\" data-ps2id-api=\"true\">Tables &#038; Figures<\/a><\/li>\n<\/ul>\n<\/li>\n<li id=\"menu-item-1973\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-1973\"><a href=\"#\" data-ps2id-api=\"true\">Events<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-4348\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-4348\"><a href=\"https:\/\/tiro.expert\/es\/webinars\/\" data-ps2id-api=\"true\">Upcoming Webinars<\/a><\/li>\n\t<li id=\"menu-item-20057\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-20057\"><a href=\"https:\/\/tiro.expert\/es\/past-webinars\/\" data-ps2id-api=\"true\">Past Webinars<\/a><\/li>\n\t<li id=\"menu-item-1975\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-1975\"><a href=\"\/subscribe\" data-ps2id-api=\"true\">Subscribe <i class=\"fas fa-external-link-alt fa-xs fa-fw\"><\/i><\/a><\/li>\n<\/ul>\n<\/li>\n<li id=\"menu-item-1974\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-has-children menu-item-1974\"><a href=\"#\" data-ps2id-api=\"true\">About TIRO<\/a>\n<ul class=\"sub-menu\">\n\t<li id=\"menu-item-1977\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1977\"><a href=\"https:\/\/tiro.expert\/es\/what-is-tiro\/\" data-ps2id-api=\"true\">What is TIRO?<\/a><\/li>\n\t<li id=\"menu-item-2407\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-2407\"><a href=\"https:\/\/tiro.expert\/es\/how-to-use-tiro\/\" data-ps2id-api=\"true\">How to Use TIRO<\/a><\/li>\n\t<li id=\"menu-item-1978\" class=\"menu-item menu-item-type-post_type menu-item-object-page menu-item-1978\"><a href=\"https:\/\/tiro.expert\/es\/contact\/\" data-ps2id-api=\"true\">Contact<\/a><\/li>\n\t<li id=\"menu-item-1979\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-1979\"><a href=\"https:\/\/thancguide.org\/\" data-ps2id-api=\"true\">THANC Guide <i class=\"fas fa-external-link-alt fa-xs fa-fw\"><\/i><\/a><\/li>\n\t<li id=\"menu-item-1980\" class=\"menu-item menu-item-type-custom menu-item-object-custom menu-item-1980\"><a href=\"https:\/\/thancfoundation.org\" data-ps2id-api=\"true\">THANC Foundation <i class=\"fas fa-external-link-alt fa-xs fa-fw\"><\/i><\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul><\/div>\t<\/div>\n<\/div>\n<div class=\"clinical-outline-mask\"><\/div>\n\n\n\n<h2 class=\"has-secondary-color has-text-color wp-block-heading\">Management Recommendations<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The JAES developed a prognostic scoring for all Stage IVa patients. A score <strong>&lt; 1<\/strong> would benefit from surgical intervention, whereas patients <strong>&gt; 2<\/strong> would be considered for systemic therapy.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">1. Prognostic Factors for Stage IVa ATC<\/h3>\n\n\n\n<ul class=\"two-column-list wp-block-list\"><li>Acute exacerbation of symptoms.<\/li><li>Tumor larger than 5 cm.<\/li><li>Distant metastases.<\/li><li>WBC &gt; 10,000.<\/li><li>T4b \u2013 gross extrathyroidal extension.<\/li><li>Age &gt; 70.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Surgical resection should be performed in highly selected patients with ATCs that are limited, (Stage IVA\/IVB) and in whom an R0\/R1 resection appears to be possible.<span id=\"7db98141-976f-460b-9690-70282b85279f\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;,&quot;3526447921&quot;,&quot;1400531341&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u20134\u200b<\/sup><\/span><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Multidisciplinary consultation should help to guide the extent of surgery that is contemplated. In general, it is not advisable to perform radical surgery that involves:<\/p>\n\n\n\n<ul class=\"two-column-list wp-block-list\"><li>A laryngectomy,&nbsp;<\/li><li>Tracheal resection,&nbsp;<\/li><li>Esophageal resection, and&nbsp;<\/li><li>Major vascular or mediastinal resections.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">The poor prognosis of ATC makes radical surgery ill-advised except in very select circumstances and considering the potential role of targeted therapy when specific actionable mutations are identified.<span id=\"d7d96799-28e2-4895-839f-b736a7c730f3\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;,&quot;3526447921&quot;,&quot;1400531341&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1\u20134\u200b<\/sup><\/span><\/p>\n\n\n\n<h3 class=\"wp-block-heading\">2. The Role of Surgery<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">The surgical management of patients with confirmed or suspected ATC is based on the following overarching principles:<\/p>\n\n\n\n<ol class=\"wp-block-list\"><li>Determining whether the disease is staged as IVA or IVB by ruling out the presence of distant metastases.<\/li><li>Accurate determination of the extent of locoregional disease by defining visceral, neurologic, vascular and osseous involvement.&nbsp;<\/li><li>Surgical management should only be undertaken if the surgeon believes that an R0 or an R1 resection can be achieved.<\/li><li>Debulking resections (R2) do not generally provide value to the patient and should not be undertaken.<\/li><li>Surgical resections that cause significant morbidity and require extensive time for wound healing prior to instituting radiation and chemotherapy should, in general, not be undertaken<\/li><li>The surgical plan should be in keeping with the patient\u2019s expressed goals of care.&nbsp;<\/li><li>Patients with systemic disease may be considered for surgical resection for palliative reasons to address or prevent airway compromise and \/or esophageal obstruction due to local disease progression.&nbsp;<\/li><li>In select circumstances, surgical exploration may be undertaken in order to determine the resectability of the disease.&nbsp;<\/li><li>While total thyroidectomy is warranted in most instances due to the common coexistence of DTC with ATC, there are select circumstances where a unilateral lobectomy is warranted when ultrasound shows no evidence of disease in the contralateral lobe and\/or the recurrent laryngeal nerve on one side is compromised preoperatively or during surgical resection.<\/li><li>Radical surgery may be considered in select individualized circumstances based on thorough multidisciplinary discussion and when the necessary ablative and reconstructive surgical expertise is available. In addition, the anticipated morbidity of the planned surgery must be consistent with the patient\u2019s wishes and informed consent.&nbsp;<\/li><li>Due to the rapid progression of ATC, the initiation of adjuvant therapy should take place within 2 to 3 weeks of surgery. The ability to achieve this important timing must be considered in determining the extent of planned surgery and reconstruction.&nbsp;<\/li><li>It is recognized that the determination of resectability may vary from surgeon to surgeon based on their individual experience and level of comfort in addressing specific visceral or vascular structures.&nbsp;<\/li><li>Neoadjuvant therapy should be considered in patients with unresectable tumors that express <em>BRAF<sup>V600E<\/sup><\/em> mutations in an effort to reduce the extent of the tumor such that surgical resection can be considered. This is true for patients who achieve a partial or a complete response to neoadjuvant therapy.&nbsp;<\/li><\/ol>\n\n\n\n<h3 class=\"wp-block-heading\">3. Role of Tracheostomy<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">In patients without impending airway compromise, we advise against preemptive tracheostomy placement.<span id=\"ccf8df2f-ecbb-4ef7-90b6-950f05d63604\" data-items=\"[&quot;3554851309&quot;]\" data-has-children=\"true\" class=\"abt-citation\" contenteditable=\"false\"><sup>\u200b1\u200b<\/sup><\/span> Prophylactic tracheostomy is, in most cases, not advisable unless there is an imminent risk of airway compromise.<span id=\"457a03e1-d2ca-4994-bede-9ed71b44a746\" data-items=\"[&quot;3554851309&quot;,&quot;1033354911&quot;]\" class=\"abt-citation\" data-has-children=\"true\" contenteditable=\"false\"><sup>\u200b1,2\u200b<\/sup><\/span><\/p>\n\n\n\n<div class=\"wp-block-media-text alignwide is-stacked-on-mobile is-vertically-aligned-center is-image-fill tw-mt-9 alignfull is-style-tw-shadow tw-rounded has-violet-08-color has-subtle-background-background-color has-text-color has-background tw-media-bottom tw-stretched-link\" style=\"grid-template-columns:30% auto\"><figure class=\"wp-block-media-text__media\" style=\"background-image:url(https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-1024x683.jpg);background-position:67% 52%\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"683\" src=\"https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-1024x683.jpg\" alt=\"selective focus photography of people sitting on chairs while writing on notebooks\" class=\"wp-image-2444 size-full\" srcset=\"https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-1024x683.jpg 1024w, https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-300x200.jpg 300w, https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-768x512.jpg 768w, https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-1536x1024.jpg 1536w, https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-600x400.jpg 600w, https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi-1200x800.jpg 1200w, https:\/\/tiro.expert\/wp-content\/uploads\/2021\/05\/hb6uwq0i4mi.jpg 1600w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading has-violet-08-color has-text-color\">Add TIROxMDS Webinars to Your Calendar<\/h2>\n\n\n\n<p class=\"has-violet-08-color has-text-color wp-block-paragraph\"><strong>In 2 quick steps, you can add our entire schedule of upcoming webinars to your calendar today!<\/strong> That way, you will never miss our upcoming lectures, presentations and case-based studies. Every Friday at 8:00 AM ET, we cover a new topic from published research.<\/p>\n\n\n\n<a title=\"Add to Calendar\" class=\"addeventstc\" data-id=\"wo408159\" href=\"https:\/\/www.addevent.com\/calendar\/wo408159\" target=\"_blank\" rel=\"nofollow noopener\">Add to Calendar<\/a>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group alignfull tw-mt-9\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<div class=\"wp-block-group alignfull tw-mt-9\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<h2 class=\"wp-block-heading has-text-align-center tw-mb-6 tw-sm-text-left tw-heading-border-bottom has-violet-color has-text-color has-h-3-font-size\">Upcoming Webinars<\/h2>\n\n\n\n\n\n\n\n\n\n\n\n<div class=\"wp-block-columns alignwide tw-mt-8 tiroxmds-grid tw-cols-rounded tw-cols-stack-md tw-cols-card tw-cols-card-white is-layout-flex wp-container-core-columns-is-layout-7387b849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading tw-mb-1 has-h-5-font-size\">Ari Wassner, MD<\/h3>\n\n\n\n<p class=\"has-text-align-left tw-mt-1 tw-text-uppercase tw-letter-spacing-tight has-violet-04-color has-text-color wp-block-paragraph\" style=\"font-size:10px\"><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong>Guest Presenter<\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<p class=\"tw-eyebrow tw-letter-spacing-tight has-violet-05-color has-text-color has-small-font-size wp-block-paragraph\"><i class=\"fas fa-fw fa-presentation-screen\"><\/i> <strong>Journal Club<\/strong><\/p>\n\n\n\n<p class=\"has-small-font-size wp-block-paragraph\"><strong><strong><strong><strong>Thyroid Function After Hemithyroidectomy in Children<\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<div class=\"wp-block-group event-actions\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p class=\"date wp-block-paragraph\">Nov. 13, 2026<\/p>\n\n\n<\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading tw-mb-1 has-h-5-font-size\">Gabriela Brenta, MD<\/h3>\n\n\n\n<p class=\"has-text-align-left tw-mt-1 tw-text-uppercase tw-letter-spacing-tight has-violet-04-color has-text-color wp-block-paragraph\" style=\"font-size:10px\"><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong>Guest Presenter<\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<p class=\"tw-eyebrow tw-letter-spacing-tight has-violet-05-color has-text-color has-small-font-size wp-block-paragraph\"><i class=\"fas fa-fw fa-presentation-screen\"><\/i> <strong>Journal Club<\/strong><\/p>\n\n\n\n<p class=\"has-small-font-size wp-block-paragraph\"><strong><strong><strong><strong>ATA 2026 Guidelines for Thyroid Disease in Preconception, Pregnancy &amp; Post Partum<\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<div class=\"wp-block-group event-actions\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p class=\"date wp-block-paragraph\">Nov. 20, 2026<\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/evt.to\/r2zbrqhwblsp\" target=\"_blank\" rel=\"noreferrer noopener\"><i class=\"fas fa-fw fa-user-check\"><\/i> RSVP<\/a><\/div>\n<\/div>\n<\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-column has-accent-background-color has-background is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading tw-mb-1 has-violet-04-color has-text-color has-h-5-font-size\">No Webinar<\/h3>\n\n\n\n<p class=\"has-background-color has-text-color has-small-font-size wp-block-paragraph\"><strong><strong>Due to Thanksgiving (US Holiday).<\/strong><\/strong><\/p>\n\n\n\n<div class=\"wp-block-group event-actions\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p class=\"date has-violet-05-color has-text-color wp-block-paragraph\">Nov. 27, 2026<\/p>\n<\/div><\/div>\n<\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-columns alignwide tw-mt-8 tiroxmds-grid tw-cols-rounded tw-cols-stack-md tw-cols-card tw-cols-card-white is-layout-flex wp-container-core-columns-is-layout-7387b849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading tw-mb-1 has-h-5-font-size\">Marika Russell, MD<\/h3>\n\n\n\n<p class=\"has-text-align-left tw-mt-1 tw-text-uppercase tw-letter-spacing-tight has-violet-04-color has-text-color wp-block-paragraph\" style=\"font-size:10px\"><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong>Guest Presenter<\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<p class=\"tw-eyebrow tw-letter-spacing-tight has-violet-05-color has-text-color has-small-font-size wp-block-paragraph\"><i class=\"fas fa-fw fa-presentation-screen\"><\/i> <strong>Journal Club<\/strong><\/p>\n\n\n\n<p class=\"has-small-font-size wp-block-paragraph\"><strong><strong><strong><strong>Scholarly Dialogue on Risk to the Recurrent Laryngeal Nerve with Thermal Ablation Procedures: A Reflection on Empirical Practices.<\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<div class=\"wp-block-group event-actions\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p class=\"date wp-block-paragraph\">Dec. 4, 2026<\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/evt.to\/8qxr8bgvhxjm\" target=\"_blank\" rel=\"noreferrer noopener\"><i class=\"fas fa-fw fa-user-check\"><\/i> RSVP<\/a><\/div>\n<\/div>\n<\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading tw-mb-1 has-h-5-font-size\">Michael Tuttle, MD<\/h3>\n\n\n\n<p class=\"has-text-align-left tw-mt-1 tw-text-uppercase tw-letter-spacing-tight has-violet-04-color has-text-color wp-block-paragraph\" style=\"font-size:10px\"><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong>Moderator<\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<p class=\"tw-eyebrow tw-letter-spacing-tight has-violet-05-color has-text-color has-small-font-size wp-block-paragraph\"><i class=\"fas fa-fw fa-comments\"><\/i> <strong>Tumor Board<\/strong><\/p>\n\n\n\n<p class=\"has-small-font-size wp-block-paragraph\"><strong><strong><strong><strong>Cases presen<\/strong><\/strong><\/strong>ted by Dr. Andy Bauer<\/strong><\/p>\n\n\n\n<div class=\"wp-block-group event-actions\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p class=\"date wp-block-paragraph\">Dec. 11, 2026<\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/evt.to\/9td6xgn8slvc\" target=\"_blank\" rel=\"noreferrer noopener\"><i class=\"fas fa-fw fa-user-check\"><\/i> RSVP<\/a><\/div>\n<\/div>\n<\/div><\/div>\n<\/div>\n\n\n\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\">\n<h3 class=\"wp-block-heading tw-mb-1 has-h-5-font-size\">Johnson Thomas, MD<\/h3>\n\n\n\n<p class=\"has-text-align-left tw-mt-1 tw-text-uppercase tw-letter-spacing-tight has-violet-04-color has-text-color wp-block-paragraph\" style=\"font-size:10px\"><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong><strong>Guest Presenter<\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<p class=\"tw-eyebrow tw-letter-spacing-tight has-violet-05-color has-text-color has-small-font-size wp-block-paragraph\"><i class=\"fas fa-fw fa-presentation-screen\"><\/i> <strong>Journal Club<\/strong><\/p>\n\n\n\n<p class=\"has-small-font-size wp-block-paragraph\"><strong><strong><strong><strong>Artificial Intelligence Applications in Thyroid Cancer Diagnosis: 2026 Update<\/strong><\/strong><\/strong><\/strong><\/p>\n\n\n\n<div class=\"wp-block-group event-actions\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<p class=\"date wp-block-paragraph\">Dec. 18, 2026<\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/evt.to\/ngl44hcwp9cn\" target=\"_blank\" rel=\"noreferrer noopener\"><i class=\"fas fa-fw fa-user-check\"><\/i> RSVP<\/a><\/div>\n<\/div>\n<\/div><\/div>\n<\/div>\n<\/div>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n<\/div><\/div>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-media-text alignwide has-media-on-the-right is-stacked-on-mobile is-vertically-aligned-center is-image-fill tw-mt-9 alignfull is-style-tw-shadow tw-rounded tw-media-bottom tw-stretched-link\" style=\"grid-template-columns:auto 49%\"><div class=\"wp-block-media-text__content\">\n<h2 class=\"wp-block-heading has-text-align-center has-violet-08-color has-text-color\">Watch Past Videos<\/h2>\n\n\n\n<p class=\"has-text-align-center has-violet-08-color has-text-color wp-block-paragraph\">We record and post all prior educational webinars to our YouTube channel.<\/p>\n\n\n\n<div class=\"wp-block-buttons is-horizontal is-content-justification-center is-layout-flex wp-container-core-buttons-is-layout-cbcdc57d wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button is-style-outline is-style-outline--2\"><a class=\"wp-block-button__link has-violet-color has-white-background-color has-text-color has-background has-link-color has-border-color wp-element-button\" href=\"https:\/\/youtube.com\/playlist?list=PLKIn9wjqDMOm0DCLhGQN77tnT4MPo_Rcg\" style=\"border-color:#5b47da;border-width:3px;border-radius:100px\" target=\"_blank\" rel=\"noreferrer noopener\">Watch now<\/a><\/div>\n<\/div>\n<\/div><figure class=\"wp-block-media-text__media\" style=\"background-image:url(https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-1024x683.jpg);background-position:55% 34%\"><img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"683\" src=\"https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-1024x683.jpg\" alt=\"Focused businessman wear headphones study online watching webinar\" class=\"wp-image-1180 size-full\" srcset=\"https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-1024x683.jpg 1024w, https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-300x200.jpg 300w, https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-768x512.jpg 768w, https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-1536x1024.jpg 1536w, https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-scaled.jpg 2048w, https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-600x400.jpg 600w, https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-1200x800.jpg 1200w, https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1203044233-watch-video-1980x1320.jpg 1980w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure><\/div>\n\n\n\n<div class=\"wp-block-group tw-rounded has-blush-light-purple-gradient-background has-background\"><div class=\"wp-block-group__inner-container is-layout-constrained wp-block-group-is-layout-constrained\">\n<h2 class=\"wp-block-heading\">\u00cates-vous de langue maternelle fran\u00e7aise?<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Notre conseil consultatif international a cr\u00e9\u00e9 une version portable de TIRO.<\/p>\n\n\n\n<div class=\"wp-block-buttons is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button\"><a class=\"wp-block-button__link wp-element-button\" href=\"https:\/\/tiro.expert\/wp-content\/uploads\/2021\/04\/TIRO.expert-Traduction-en-francais-des-recommandations.docx.pdf\" target=\"_blank\" rel=\"noreferrer noopener\"><i class=\"fas fa-fw fa-cloud-arrow-down\"><\/i> t\u00e9l\u00e9charger le PDF<\/a><\/div>\n<\/div>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-group alignfull has-subtle-background-background-color has-background\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<div class=\"wp-block-group tw-mb-0 tw-mt-0\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<section aria-label=\"Bibliography\" class=\"wp-block-abt-bibliography abt-bibliography\" role=\"region\"><h3 class=\"abt-bibliography__heading\">References<\/h3><ol class=\"abt-bibliography__body\" data-entryspacing=\"1\" data-maxoffset=\"3\" data-linespacing=\"1\" data-second-field-align=\"flush\"><li id=\"3554851309\">  <div class=\"csl-entry\">\n    <div class=\"csl-left-margin\">1. <\/div><div class=\"csl-right-inline\">Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. <i>Thyroid<\/i>. Published online January 2016:1-133. doi:<a href=\"https:\/\/doi.org\/10.1089\/thy.2015.0020\">10.1089\/thy.2015.0020<\/a><\/div>\n  <\/div>\n<\/li><li id=\"1033354911\">  <div class=\"csl-entry\">\n    <div class=\"csl-left-margin\">2. <\/div><div class=\"csl-right-inline\">Haddad RI, Nasr C, Bischoff L, et al. NCCN Guidelines Insights: Thyroid Carcinoma, Version 2.2018. <i>J Natl Compr Canc Netw<\/i>. Published online December 2018:1429-1440. doi:<a href=\"https:\/\/doi.org\/10.6004\/jnccn.2018.0089\">10.6004\/jnccn.2018.0089<\/a><\/div>\n  <\/div>\n<\/li><li id=\"3526447921\">  <div class=\"csl-entry\">\n    <div class=\"csl-left-margin\">3. <\/div><div class=\"csl-right-inline\">Ito Y, Onoda N, Okamoto T. The revised clinical practice guidelines on the management of thyroid tumors by the Japan Associations of Endocrine Surgeons: Core questions and recommendations for treatments of thyroid cancer. <i>Endocr J<\/i>. Published online 2020:669-717. doi:<a href=\"https:\/\/doi.org\/10.1507\/endocrj.ej20-0025\">10.1507\/endocrj.ej20-0025<\/a><\/div>\n  <\/div>\n<\/li><li id=\"1400531341\">  <div class=\"csl-entry\">\n    <div class=\"csl-left-margin\">4. <\/div><div class=\"csl-right-inline\">Filetti S, Durante C, Hartl D, et al. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. <i>Annals of Oncology<\/i>. Published online December 2019:1856-1883. doi:<a href=\"https:\/\/doi.org\/10.1093\/annonc\/mdz400\">10.1093\/annonc\/mdz400<\/a><\/div>\n  <\/div>\n<\/li><\/ol><\/section>\n<\/div><\/div>\n<\/div><\/div>\n","protected":false},"excerpt":{"rendered":"<p>Recomendaciones de manejo La JAES desarroll\u00f3 una puntuaci\u00f3n de pron\u00f3stico para todos los pacientes en estadio IVa. Una puntuaci\u00f3n  2 se considerar\u00edan para la terapia sist\u00e9mica. 1. Factores pron\u00f3sticos para el ATC en estadio IVa Exacerbaci\u00f3n aguda de los s\u00edntomas. Tumor de m\u00e1s de 5 cm. Met\u00e1stasis distantes. CBC &gt; 10.000. T4b -...<\/p>","protected":false},"author":1,"featured_media":178,"parent":4463,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"templates\/template-cover.php","meta":{"_acf_changed":false,"inline_featured_image":false,"_uag_custom_page_level_css":"","footnotes":""},"class_list":["post-4495","page","type-page","status-publish","has-post-thumbnail","hentry"],"acf":[],"aioseo_notices":[],"aioseo_head":"\n\t\t<!-- All in One SEO Pro 5.0.5 - aioseo.com -->\n\t<meta name=\"description\" content=\"It is important to evaluate a thyroid cancer patient&#039;s prognosis in order to select the best treatment option. Find out when &amp; why surgery should be performed.\" \/>\n\t<meta name=\"robots\" content=\"nosnippet, max-image-preview:large, max-video-preview:-1\" \/>\n\t<meta name=\"google-site-verification\" content=\"dgn_KNbWOqdQMThGOuzuLswqwKwBsjcS82PzbL7RTr4\" \/>\n\t<meta name=\"msvalidate.01\" content=\"665B47E811A7F57E1C97131210D3FD3A\" \/>\n\t<link rel=\"canonical\" href=\"https:\/\/tiro.expert\/es\/recommendations\/atc\/surgical-management\/\" \/>\n\t\t<meta name=\"generator\" content=\"All in One SEO Pro (AIOSEO) 5.0.5\" \/>\n\t\t<script type=\"application\/ld+json\" class=\"aioseo-schema\">\n\t\t\t{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/tiro.expert\\\/es\\\/recommendations\\\/atc\\\/surgical-management\\\/#breadcrumblist\",\"itemListElement\":[{\"@type\":\"ListItem\",\"@id\":\"https:\\\/\\\/tiro.expert\\\/es\\\/#listItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/tiro.expert\\\/es\\\/\",\"nextItem\":{\"@type\":\"ListItem\",\"@id\":\"https:\\\/\\\/tiro.expert\\\/es\\\/recommendations\\\/#listItem\",\"name\":\"Care Recommendations\"}},{\"@type\":\"ListItem\",\"@id\":\"https:\\\/\\\/tiro.expert\\\/es\\\/recommendations\\\/#listItem\",\"position\":2,\"name\":\"Care Recommendations\",\"item\":\"https:\\\/\\\/tiro.expert\\\/es\\\/recommendations\\\/\",\"nextItem\":{\"@type\":\"ListItem\",\"@id\":\"https:\\\/\\\/tiro.expert\\\/es\\\/recommendations\\\/atc\\\/#listItem\",\"name\":\"Anaplastic Thyroid Cancer\"},\"previousItem\":{\"@type\":\"ListItem\",\"@id\":\"https:\\\/\\\/tiro.expert\\\/es\\\/#listItem\",\"name\":\"Home\"}},{\"@type\":\"ListItem\",\"@id\":\"https:\\\/\\\/tiro.expert\\\/es\\\/recommendations\\\/atc\\\/#listItem\",\"position\":3,\"name\":\"Anaplastic Thyroid Cancer\",\"item\":\"https:\\\/\\\/tiro.expert\\\/es\\\/recommendations\\\/atc\\\/\",\"nextItem\":{\"@type\":\"ListItem\",\"@id\":\"https:\\\/\\\/tiro.expert\\\/es\\\/recommendations\\\/atc\\\/surgical-management\\\/#listItem\",\"name\":\"Surgical Management\"},\"previousItem\":{\"@type\":\"ListItem\",\"@id\":\"https:\\\/\\\/tiro.expert\\\/es\\\/recommendations\\\/#listItem\",\"name\":\"Care Recommendations\"}},{\"@type\":\"ListItem\",\"@id\":\"https:\\\/\\\/tiro.expert\\\/es\\\/recommendations\\\/atc\\\/surgical-management\\\/#listItem\",\"position\":4,\"name\":\"Surgical Management\",\"previousItem\":{\"@type\":\"ListItem\",\"@id\":\"https:\\\/\\\/tiro.expert\\\/es\\\/recommendations\\\/atc\\\/#listItem\",\"name\":\"Anaplastic Thyroid Cancer\"}}]},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/tiro.expert\\\/es\\\/#organization\",\"name\":\"Thyroid Int'l Recommendations Online (TIRO)\",\"description\":\"Thyroid Int'l Recommendations Online\",\"url\":\"https:\\\/\\\/tiro.expert\\\/es\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"url\":\"https:\\\/\\\/tiro.expert\\\/wp-content\\\/uploads\\\/2021\\\/01\\\/TIRO-secondary-logo-siteID.png\",\"@id\":\"https:\\\/\\\/tiro.expert\\\/es\\\/recommendations\\\/atc\\\/surgical-management\\\/#organizationLogo\",\"width\":847,\"height\":278,\"caption\":\"TIRO Thyroid International Recommendations Online secondary logo\"},\"image\":{\"@id\":\"https:\\\/\\\/tiro.expert\\\/es\\\/recommendations\\\/atc\\\/surgical-management\\\/#organizationLogo\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/thancfoundation\",\"https:\\\/\\\/twitter.com\\\/thancfoundation\",\"https:\\\/\\\/instagram.com\\\/thancfoundation\\\/\",\"https:\\\/\\\/www.youtube.com\\\/channel\\\/UC4Y_bz_8BmgUU96NWdpBkdw\\\/feed\"]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/tiro.expert\\\/es\\\/recommendations\\\/atc\\\/surgical-management\\\/#webpage\",\"url\":\"https:\\\/\\\/tiro.expert\\\/es\\\/recommendations\\\/atc\\\/surgical-management\\\/\",\"name\":\"Surgical Management \\u2023 Anaplastic Thyroid Cancer \\u2023 TIRO\",\"description\":\"It is important to evaluate a thyroid cancer patient's prognosis in order to select the best treatment option. Find out when & why surgery should be performed.\",\"inLanguage\":\"es-MX\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/tiro.expert\\\/es\\\/#website\"},\"breadcrumb\":{\"@id\":\"https:\\\/\\\/tiro.expert\\\/es\\\/recommendations\\\/atc\\\/surgical-management\\\/#breadcrumblist\"},\"image\":{\"@type\":\"ImageObject\",\"url\":\"https:\\\/\\\/tiro.expert\\\/wp-content\\\/uploads\\\/2020\\\/06\\\/iStock-1015934048-surgery-1024x576-1.jpg\",\"@id\":\"https:\\\/\\\/tiro.expert\\\/es\\\/recommendations\\\/atc\\\/surgical-management\\\/#mainImage\",\"width\":1024,\"height\":576},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/tiro.expert\\\/es\\\/recommendations\\\/atc\\\/surgical-management\\\/#mainImage\"},\"datePublished\":\"2022-01-26T15:38:21-05:00\",\"dateModified\":\"2022-08-16T13:17:24-05:00\"},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/tiro.expert\\\/es\\\/#website\",\"url\":\"https:\\\/\\\/tiro.expert\\\/es\\\/\",\"name\":\"TIRO\",\"description\":\"Thyroid Int'l Recommendations Online\",\"inLanguage\":\"es-MX\",\"publisher\":{\"@id\":\"https:\\\/\\\/tiro.expert\\\/es\\\/#organization\"}}]}\n\t\t<\/script>\n\t\t<!-- All in One SEO Pro -->\r\n\t\t<title>Surgical Management \u2023 Anaplastic Thyroid Cancer \u2023 TIRO<\/title>\n\n","aioseo_head_json":{"title":"Manejo quir\u00fargico \u2023 C\u00e1ncer de tiroides anapl\u00e1sico \u2023 TIRO","description":"Es importante evaluar el pron\u00f3stico de un paciente con c\u00e1ncer de tiroides para seleccionar la mejor opci\u00f3n de tratamiento. Descubra cu\u00e1ndo y por qu\u00e9 debe realizarse la cirug\u00eda.","canonical_url":"https:\/\/tiro.expert\/es\/recommendations\/atc\/surgical-management\/","robots":"nosnippet, max-image-preview:large, max-video-preview:-1","keywords":"","webmasterTools":{"google-site-verification":"dgn_KNbWOqdQMThGOuzuLswqwKwBsjcS82PzbL7RTr4","msvalidate.01":"665B47E811A7F57E1C97131210D3FD3A","miscellaneous":""},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"BreadcrumbList","@id":"https:\/\/tiro.expert\/es\/recommendations\/atc\/surgical-management\/#breadcrumblist","itemListElement":[{"@type":"ListItem","@id":"https:\/\/tiro.expert\/es\/#listItem","position":1,"name":"Home","item":"https:\/\/tiro.expert\/es\/","nextItem":{"@type":"ListItem","@id":"https:\/\/tiro.expert\/es\/recommendations\/#listItem","name":"Care Recommendations"}},{"@type":"ListItem","@id":"https:\/\/tiro.expert\/es\/recommendations\/#listItem","position":2,"name":"Care Recommendations","item":"https:\/\/tiro.expert\/es\/recommendations\/","nextItem":{"@type":"ListItem","@id":"https:\/\/tiro.expert\/es\/recommendations\/atc\/#listItem","name":"Anaplastic Thyroid Cancer"},"previousItem":{"@type":"ListItem","@id":"https:\/\/tiro.expert\/es\/#listItem","name":"Home"}},{"@type":"ListItem","@id":"https:\/\/tiro.expert\/es\/recommendations\/atc\/#listItem","position":3,"name":"Anaplastic Thyroid Cancer","item":"https:\/\/tiro.expert\/es\/recommendations\/atc\/","nextItem":{"@type":"ListItem","@id":"https:\/\/tiro.expert\/es\/recommendations\/atc\/surgical-management\/#listItem","name":"Surgical Management"},"previousItem":{"@type":"ListItem","@id":"https:\/\/tiro.expert\/es\/recommendations\/#listItem","name":"Care Recommendations"}},{"@type":"ListItem","@id":"https:\/\/tiro.expert\/es\/recommendations\/atc\/surgical-management\/#listItem","position":4,"name":"Surgical Management","previousItem":{"@type":"ListItem","@id":"https:\/\/tiro.expert\/es\/recommendations\/atc\/#listItem","name":"Anaplastic Thyroid Cancer"}}]},{"@type":"Organization","@id":"https:\/\/tiro.expert\/es\/#organization","name":"Thyroid Int'l Recommendations Online (TIRO)","description":"Thyroid Int'l Recommendations Online","url":"https:\/\/tiro.expert\/es\/","logo":{"@type":"ImageObject","url":"https:\/\/tiro.expert\/wp-content\/uploads\/2021\/01\/TIRO-secondary-logo-siteID.png","@id":"https:\/\/tiro.expert\/es\/recommendations\/atc\/surgical-management\/#organizationLogo","width":847,"height":278,"caption":"TIRO Thyroid International Recommendations Online secondary logo"},"image":{"@id":"https:\/\/tiro.expert\/es\/recommendations\/atc\/surgical-management\/#organizationLogo"},"sameAs":["https:\/\/www.facebook.com\/thancfoundation","https:\/\/twitter.com\/thancfoundation","https:\/\/instagram.com\/thancfoundation\/","https:\/\/www.youtube.com\/channel\/UC4Y_bz_8BmgUU96NWdpBkdw\/feed"]},{"@type":"WebPage","@id":"https:\/\/tiro.expert\/es\/recommendations\/atc\/surgical-management\/#webpage","url":"https:\/\/tiro.expert\/es\/recommendations\/atc\/surgical-management\/","name":"Surgical Management \u2023 Anaplastic Thyroid Cancer \u2023 TIRO","description":"It is important to evaluate a thyroid cancer patient's prognosis in order to select the best treatment option. Find out when & why surgery should be performed.","inLanguage":"es-MX","isPartOf":{"@id":"https:\/\/tiro.expert\/es\/#website"},"breadcrumb":{"@id":"https:\/\/tiro.expert\/es\/recommendations\/atc\/surgical-management\/#breadcrumblist"},"image":{"@type":"ImageObject","url":"https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1015934048-surgery-1024x576-1.jpg","@id":"https:\/\/tiro.expert\/es\/recommendations\/atc\/surgical-management\/#mainImage","width":1024,"height":576},"primaryImageOfPage":{"@id":"https:\/\/tiro.expert\/es\/recommendations\/atc\/surgical-management\/#mainImage"},"datePublished":"2022-01-26T15:38:21-05:00","dateModified":"2022-08-16T13:17:24-05:00"},{"@type":"WebSite","@id":"https:\/\/tiro.expert\/es\/#website","url":"https:\/\/tiro.expert\/es\/","name":"TIRO","description":"Thyroid Int'l Recommendations Online","inLanguage":"es-MX","publisher":{"@id":"https:\/\/tiro.expert\/es\/#organization"}}]}},"aioseo_meta_data":{"post_id":"4495","title":"#t\u00edtulo_de_la_publicaci\u00f3n #separador_sa #t\u00edtulo_principal #separador_sa #t\u00edtulo_del_sitio","description":"Es importante evaluar el pron\u00f3stico de un paciente con c\u00e1ncer de tiroides para poder elegir la mejor opci\u00f3n de tratamiento. Descubre cu\u00e1ndo y por qu\u00e9 se debe realizar la cirug\u00eda.","keywords":[],"keyphrases":{"focus":{"keyphrase":"","score":0,"analysis":{"keyphraseInTitle":{"score":0,"maxScore":9,"error":1}}},"additional":[]},"primary_term":null,"canonical_url":null,"og_title":null,"og_description":null,"og_object_type":"default","og_image_type":"default","og_image_url":null,"og_image_width":null,"og_image_height":null,"og_image_custom_url":null,"og_image_custom_fields":null,"og_video":"","og_custom_url":null,"og_article_section":null,"og_article_tags":[],"twitter_use_og":false,"twitter_card":"default","twitter_image_type":"default","twitter_image_url":null,"twitter_image_custom_url":null,"twitter_image_custom_fields":null,"twitter_title":null,"twitter_description":null,"schema":{"blockGraphs":[],"customGraphs":[],"default":{"data":{"Article":[],"Course":[],"Dataset":[],"FAQPage":[],"Movie":[],"Person":[],"Product":[],"ProductReview":[],"Car":[],"Recipe":[],"Service":[],"SoftwareApplication":[],"WebPage":[]},"graphName":"","isEnabled":true},"graphs":[]},"schema_type":"default","schema_type_options":"{\"article\":{\"articleType\":\"BlogPosting\"},\"course\":{\"name\":\"\",\"description\":\"\",\"provider\":\"\"},\"faq\":{\"pages\":[]},\"product\":{\"reviews\":[]},\"recipe\":{\"ingredients\":[],\"instructions\":[],\"keywords\":[]},\"software\":{\"reviews\":[],\"operatingSystems\":[]},\"webPage\":{\"webPageType\":\"WebPage\"},\"blockGraphs\":[]}","pillar_content":false,"robots_default":true,"robots_noindex":false,"robots_noarchive":false,"robots_nosnippet":false,"robots_nofollow":false,"robots_noimageindex":false,"robots_noodp":false,"robots_notranslate":false,"robots_max_snippet":"-1","robots_max_videopreview":"-1","robots_max_imagepreview":"large","priority":null,"frequency":"default","local_seo":null,"seo_analyzer_scan_date":"2026-11-09 06:46:59","breadcrumb_settings":null,"limit_modified_date":false,"open_ai":null,"ai":null,"created":"2022-01-26 21:26:08","updated":"2026-11-09 06:46:59","focus_keyword":null,"additional_keywords":null,"truseo_locale":null},"featured_image_src":"https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1015934048-surgery-1024x576-1.jpg","featured_image_src_square":"https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1015934048-surgery-1024x576-1.jpg","uagb_featured_image_src":{"full":["https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1015934048-surgery-1024x576-1.jpg",1024,576,false],"thumbnail":["https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1015934048-surgery-1024x576-1-150x150.jpg",150,150,true],"medium":["https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1015934048-surgery-1024x576-1-300x169.jpg",300,169,true],"medium_large":["https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1015934048-surgery-1024x576-1-768x432.jpg",700,394,true],"large":["https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1015934048-surgery-1024x576-1.jpg",700,394,false],"1536x1536":["https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1015934048-surgery-1024x576-1.jpg",1024,576,false],"2048x2048":["https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1015934048-surgery-1024x576-1.jpg",1024,576,false],"trp-custom-language-flag":["https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1015934048-surgery-1024x576-1.jpg",18,10,false],"gb-block-post-grid-landscape":["https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1015934048-surgery-1024x576-1.jpg",600,338,false],"gb-block-post-grid-square":["https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1015934048-surgery-1024x576-1.jpg",600,338,false],"post-thumbnail":["https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1015934048-surgery-1024x576-1.jpg",1024,576,false],"twentytwenty-fullscreen":["https:\/\/tiro.expert\/wp-content\/uploads\/2020\/06\/iStock-1015934048-surgery-1024x576-1.jpg",1024,576,false]},"uagb_author_info":{"display_name":"THANC Foundation","author_link":"https:\/\/tiro.expert\/es\/author\/hncg2-admin\/"},"uagb_comment_info":0,"uagb_excerpt":"Management Recommendations The JAES developed a prognostic scoring for all Stage IVa patients. A score &lt; 1 would benefit from surgical intervention, whereas patients &gt; 2 would be considered for systemic therapy. 1. Prognostic Factors for Stage IVa ATC Acute exacerbation of symptoms. Tumor larger than 5 cm. Distant metastases. WBC &gt; 10,000. T4b \u2013&hellip;","publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"_links":{"self":[{"href":"https:\/\/tiro.expert\/es\/wp-json\/wp\/v2\/pages\/4495","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tiro.expert\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/tiro.expert\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/tiro.expert\/es\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/tiro.expert\/es\/wp-json\/wp\/v2\/comments?post=4495"}],"version-history":[{"count":0,"href":"https:\/\/tiro.expert\/es\/wp-json\/wp\/v2\/pages\/4495\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/tiro.expert\/es\/wp-json\/wp\/v2\/pages\/4463"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tiro.expert\/es\/wp-json\/wp\/v2\/media\/178"}],"wp:attachment":[{"href":"https:\/\/tiro.expert\/es\/wp-json\/wp\/v2\/media?parent=4495"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}