Would you offer post op adjuvant radiation following keloid resection if it would result in a significant dose being delivered to the patient's thyroid gland?

This is less of a "medical" answer than one about patient values. As a specialty, we are remarkably conservative, especially when it comes to benign disease (see our reluctance to treat osteoarthritis, compared to other nations).

Post-op treatment of keloids is essentially an aesthetic choice. We know that the risk of second malignancy at the doses we use is very, very small. People's self-image and psyche (especially young people) can be affected by something that is visually unpleasing. As an example, I have had difficult discussions with teenagers and their parents. In the past, I was much more reluctant to offer treatment, but having my own children now, I believe this situation to be more complex.

In this case, if a keloid recurrence ...