Surgical treatment of recurrent thyroid carcinoma

Abstract

Recurrent thyroid tumors are much less frequent but more aggressive than primary tumors. The aim is to find out their characteristics, aggressiveness and the possibility of radical surgical excision as well as the frequency of complications. METHOD AND MATERIAL: Retrospective study on 69 patients operated for recurrent thyroid tumors. RESULTS: Recurrent tumors were found in 42 patients with papillary, 11 with follicular (8 with Hurthle), 9 with medullary and 7 with anaplastic thyroid tumors. Relapse in thyroid bed on dominant side had 41 patients (59.4%), relapse on the opposite side we found in 19 patients (27.5%) and relapse in lymph nodes outside of thyroid bed in 37 patients (53.6%). In 33/69 patients, the first procedure was incomplete (reduction in 5, partial resection in 19, hemithyroidectomy in 9). The second procedure was incomplete in 14, near total thyroidectomy in 2, total thyroidectomy in 33 and dissection of lymph nodes in 33, among them in 20 with the operation in thyroid bed. Pre-operative recurrent nerve palsy had 2 patients and transitional recurrent nerve palsy occurred after second procedure in 2 patients. Among 33 patients after thyroidectomy for recurrent tumor, postoperative hypoparathyroidism occurred in 8 (24.2%), of whom in 2 permanent (6%). In the group of 54 patients with recurrent differentiated thyroid cancer, radioiodine therapy after first operation had received only 7 patients (13%). CONCLUSION: The main causes of thyroid cancer relapse are incomplete first procedure and aggressiveness of cancer. It is not always possible to excise the complete recurrent tumor. After surgery for papillary cancer, radioiodine therapy is seldom used.