Safety of the Completion Thyroidectomy in the Management of Well-Differentiated Thyroid Carcinoma

Park, Sang Hyeop; Kim, Say June; Lee, Dong Ho; Sung, Ki Young; Suh, Young Jin; Kim, Jeong Soo; Oh, Se Jeong; Jeon, Hae Myung; Chun, Chung Soo

Abstract

PURPOSE
Completion thyroidectomy is the removal of any thyroid tissue that remains after less than total thyroidectomy. The purpose of the present study is to review the processes and pathologic results leading to completion thyroidectomy, and to determine the degree of increased morbidity with completion thyroidectomy. METHODS: The hospital records of 60 patients treated from January 1981 to December 2000 were retrospectively reviewed. RESULTS: The subjects were 48 women and 12 men with ages ranging from 17 to 72 years (mean 46.3 years). Initial pathologic results were 46 cases of papillary carcinoma (76.6%), 12 of follicular carcinoma (20%), one of medullary carcinoma and one of Hurthle cell carcinoma. Initial operations were lobectomy in 51 cases, bilateral subtotal thyroidectomy in 6 and enucleation in 3. Completion thyroidectomies were performed due to tumor recurrence in 32 cases, confirmed malignancy following permanent sections in 21 and others in 7. Twenty-one of the cases were performed within 6 months after initial operations. Residual or recurrent carcinoma was found in 36 cases of the completion thyroidectomy specimens (60%). Postoperative complications were as follows: transient and permanent recurrent laryngeal nerve palsy occurred in 1 (1.7%) and 2 (3.3%) cases, respectively, transient and permanent hypoparathyroidism occurred separately in 15 (25%) and 4 (6.7%) cases, respectively, and there was one case of hematoma (1.7%) and one of wound infection (1.7%). There was no correlation between complications and the interval between initial surgery and reoperation. CONCLUSION: Completion thyroidectomy could be performed with minimal morbidity and might prevent the development of regional recurrence by eliminating an unsuspected focus of cancer. The surgeon should not feel obligated to perform a total thyroidectomy if the diagnosis of cancer is not secure, because the second stage operation can be performed over a wide time interval, allowing the physician and patient considerable latitude for decision making.