J Endocr Surg.  2019 Sep;19(3):68-75. 10.16956/jes.2019.19.3.68.

Causes, Timing, and Safety of Completion Thyroidectomy during the Follow-up Period after Lobectomy: a Single-Center Experience

• Lee JY
• Kang SH
• Lee SJ
• Choi JE

• KMID: 2458704
• DOI: http://doi.org/10.16956/jes.2019.19.3.68

Abstract

PURPOSE
Thyroid lobectomy is a standard procedure for patients with papillary thyroid carcinoma (PTC) with tumor size <4 cm and clinically negative lymph nodes (LNs) and is performed more frequently than total thyroidectomy. Completion thyroidectomy (CT) is an unexpected operation after lobectomy that has an unpredictable complication rate. In this study, we evaluated the causes, timing, and safety of CT based on our experience.
METHODS
From January 2005 to December 2016, 7,731 patients underwent thyroid surgery in our institution. In this study, we included 63 patients who underwent CT for recurrent or contralateral thyroid disease during the follow-up period after lobectomy for PTC through retrospective chart review. We analyzed the causes and timing of CT, initial clinicopathologic factors of PTC, and the complication rate.
RESULTS
All patients underwent initial thyroid lobectomy for PTC. On initial pathology, mean tumor size was 0.69 cm and 7.9% (5/63) patients had central LN metastasis. Patients underwent CT after a mean of 68.4 months (6-388 months). The cause of CT was local or regional recurrence in 52.4% (30/63) of patients, contralateral PTC in 49.2% (31/63), and contralateral benign nodule in 3.17% (2/63). After CT, persistent hypoparathyroidism occurred in 1.58% (1/63), hoarseness in 1.58% (1/63), and wound infection in 1.58% (1/63).
CONCLUSION
CT may be performed for recurrent or non-recurrent causes anytime during the patient's lifetime after lobectomy. The postoperative complication rate is relatively low. Special attention should be paid during CT.

Keyword

Papillary thyroid cancer; Recurrence; Reoperation; Postoperative complications

MeSH Terms

Follow-Up Studies*
Hoarseness
Humans
Hypoparathyroidism
Lymph Nodes
Neoplasm Metastasis
Pathology
Postoperative Complications
Recurrence
Reoperation
Retrospective Studies
Thyroid Diseases
Thyroid Gland
Thyroid Neoplasms
Thyroidectomy*
Wound Infection

Figure

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  Fig. 1 Study cohort. FTC = follicular thyroid carcinoma; PTC = papillary thyroid carcinoma.

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  Fig. 2 The number of patients who received CT for recurrence (recur CT group) and non-recurrent causes (non-recur CT group) during the follow-up period after thyroid lobectomy. Within 4 years after lobectomy, 48.4% of patients in the recur CT group and 51.6% in the non-recur CT group underwent CT. CT = completion thyroidectomy.

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