Safety of Completion Thyroidectomy for Initially Misdiagnosed Thyroid Carcinoma

Abstract

Background Completion thyroidectomy is defined as the surgical removal of the remnant thyroid tissue following procedures less than total or near-total thyroidectomy. Whether thyroid re-operations are associated with an increased complication risk is controversial. Objective: A retrospective analysis was done for the patients undergoing completion thyroidectomy for cancer of thyroid who underwent surgery elsewhere for solitary nodule. The incidence of residual tumor and or residual thyroid tissue and surgical complication rates in patients after reoperation were analyzed in this study. Material And Methods:A total of 53 patients who underwent thyroid surgery for solitary nodule as initial surgery elsewhere and referred to our institute for completion thyroidectomy when the histopathology revealed malignancy, were studied. Results:There were 53 patients, 44females and 9 males. Their mean age was 34 +/- 11.8years (range 19 to 65 years). After initial surgery, the histopathology revealed papillary carcinoma in 46 patients (87%), follicular carcinoma in 6 (11%), medullary cell carcinoma in 1(2%). Thirteen out of 53 patients had recurrent laryngeal nerve palsy after initial surgery (24.5%). After completion thyroidectomy, 17 of the 53 patients revealed malignancy in the remaining thyroid specimen (32%), papillary carcinoma in 16 patients (30%), follicular in one (2%). One or more parathyroid glands was identified and preserved in 52 patients (98%). No patient had additional recurrent nerve injury at the second surgery. The mean serum calcium value preoperatively was 8.98 +/- 0.39 and post-surgery serum calcium 8.74 +/- 1.15. Mean follow up was 18 months. Transient hypoparathroidism occurred in 3 patients (6.2%). Permanent and symptomatic hypoparathyroidism occurred in eight patients(16.6%). Five patients were lost to follow up. Five of the patients with permanent hypoparathyroidism had undergone bilateral central compartment dissection. Conclusions Completion thyroidectomy is a safe and appropriate option in the management of well differentiated thyroid cancer. It removes disease and or thyroid tissue from the thyroid bed on both sides including isthmus. Revision surgery carries a low risk of recurrent laryngeal nerve damage, but a higher risk of permanent hypoparathyroidism especially in patients who have undergone central compartment dissection.