Safety of Completion Thyroidectomy for Initially Misdiagnosed Thyroid Carcinoma

Abstract

IntroductionCompletion thyroidectomy is defined as the surgical removal of the remnant thyroid tissue following procedures of less than total or near-total thyroidectomy. Whether thyroid reoperations are associated with an increased complication risk is controversial.ObjectiveA retrospective analysis was done of patients undergoing completion thyroidectomy for cancer of the thyroid who had undergone surgery elsewhere for solitary thyroid nodule. The incidence of surgical complications in these patients after reoperation was investigated in this study.Material and methodsThe study included a total of 53 patients who had undergone thyroid lobectomy for a solitary nodule as initial surgery elsewhere and were referred to our institute for completion thyroidectomy when the histopathology revealed malignancy.ResultsThere were 53 patients, 43 females and 10 males. Their mean age was 34.7±12.12 years (range 19–65 years). After initial surgery, the histopathology revealed papillary carcinoma in 46 patients (86.8%), follicular carcinoma in 7 (13.2%). Fourteen out of 53 patients had recurrent laryngeal nerve palsy after initial surgery (26.4%). None of the patients had clinical hypocalcemia after the first surgery. One or more parathyroid glands were identified and preserved in 52 patients (98.1%) in the process of completion thyroidectomy. No patient had additional recurrent nerve injury at the second surgery. The mean serum calcium value preoperatively was 8.96±0.39 mg/dL, and six months after surgery serum calcium was 8.74±0.56 mg/dL. Mean follow-up was 18 months. Transient hypoparathyroidism occurred in 24.5% patients. Five patients were lost to follow-up. Permanent and symptomatic hyperparathyroidism occurred in eight patients (16.67%).ConclusionsCompletion thyroidectomy is a safe and appropriate option in the management of well-differentiated thyroid cancer. It removes disease on the ipsilateral and contralateral side of the thyroid and carries a low risk of recurrent laryngeal nerve damage, but a higher risk of permanent hypoparathyroidism.

Thyroidectomy Related Complications in Post-Thyroid Lobectomy (Unilateral) in Addition to Thyroid Isthmusectomy

“…16 The risk of intermittent hypothyroidism is reported as 5.8% to 24.5% in earlier studies accompanied by permanent hypocalcaemia. 2,17 In present research the prevalence of seroma formation was only 3.3%. This low prevalence may have caused none of the cases presenting wound infection formation.…”

“…1 Around the globe the presentation of these tumours is as single identifiable thyroid node. 2 The diagnosis of thyroid tumour is performed through sonographic imaging as well as cytological assessment of aspirated fine needle samples. Thyroid lobectomy is a standard operating procedure for unilateral thyroid abrasions such as thy-3 and thy-4.…”

A National Comparison of Postoperative Outcomes in Completion Thyroidectomy and Total Thyroidectomy

“…CT has been described as having a higher surgical complication rate than that of total thyroidectomy (TT), which is possibly related to adhesions from the initial procedure 12–14 . There are also studies that support comparable rates of complications between the procedures 10,15,16 .…”

Re-do transoral robotic thyroidectomy is feasible: preliminary results of the surgical feasibility and efficacy of completion transoral robotic thyroidectomy: cohort study

“…However, the tissue alterations that occur after the initial surgery, such as inflammation, fibrosis, adhesions, and swelling, can complicate the accurate identification of anatomical landmarks during completion thyroidectomy 22 . Consequently, completion thyroidectomy is often perceived as carrying an elevated risk of postoperative complications, including potential injuries to the skin flap or trachea 23 , as well as increased surgical complexity, which can lead to longer operation times compared to the initial surgery 24 . While some studies have suggested that the risks of a two-stage approach of initial thyroid lobectomy followed by completion thyroidectomy may not significantly differ from those of an initial total thyroidectomy 25 , the technical demands of completion thyroidectomy remain significant.…”