Multicentricidade no carcinoma diferenciado da tireóide

Abstract

The treatment of choice for the well differentiated thyroid carcinoma has always been controversial. Aim: to analyze tumor invasion of the thyroid gland's contralateral lobe in cases of differentiated carcinoma, correlating risk/benefit with the complications of a second surgical approach. Materials and methods: Retrospective study, from 1998 to 2006, of 27 patients undergoing less than total thyroidectomy: lobectomy (21), subtotal thyroidectomy (5) or isthmusectomy (1). Gender, age, type of surgery, complications, histopathological analysis and invasion of the contralateral lobe were analyzed. Patients' ages varied from 17 to 89; the most frequent histopathological pattern was the classical papillary carcinoma (18 cases), followed by follicular carcinoma (6); the follicular variant of the papillary carcinoma (2) and the Hürthle cell carcinoma (1). Twenty-one patients underwent full thyroidectomies, from 15 to 30 days after the first intervention. Results: the contralateral lobe analysis was negative for carcinoma in 16 (76.5%) and positive in the other 5 (23.8%) patients. The complications observed were temporary dysphonia (3 cases) and hypoparathyroidism (2 cases, one permanent). Conclusions: total thyroidectomy is important in the treatment of differentiated thyroid carcinomas, because there is a high contralateral spread rate (23.8%). It is a procedure without mortality, which bears few complications.