The incidence of bilateral well‐differentiated thyroid cancer found at completion thyroidectomy

Abstract

The purpose of this study was to evaluate the surgical outcome of completion thyroidectomy in patients with presumed unilateral well-differentiated thyroid cancer (WDTC). The medical records of all patients having had unilateral thyroid lobectomy for WDTC, who subsequently underwent completion thyroidectomy, were reviewed. From 1980 to 1991, 60 patients with WDTC underwent completion thyroidectomy. Forty-seven patients had presumed unilateral WDTC, with no evidence of residual disease prior to their completion thyroidectomy. Twenty-five (53%) of these patients were found to have residual neoplastic disease in the neck. In 20 (43%) of 47 patients, a focus of cancer was found in the remaining thyroid lobe and in 5 additional patients no cancer was found in the contralateral lobe, however, unsuspected nodal disease was found. The remaining 13 of the 60 patients presented with either regional recurrence (n = 12) or distant metastases (n = 1) at the time of their completion thyroidectomy. All (92%) but 1 of these 13 patients had cancer in the remaining thyroid lobe. Multifocal disease in the primary lobe was associated with bilateral thyroid cancer (p less than 0.01). Complications were infrequent; transient hypocalcemia occurred in 5 (8%) patients, permanent hypoparathyroidism occurred in 1 (1.7%) patient, and transient recurrent laryngeal nerve palsy occurred in 3 (5%) patients. Residual WDTC was found in 37 (62%) of 60 patients undergoing completion thyroidectomy. Multifocal disease in the primary resected lobe was associated with a high incidence of contralateral thyroid cancer. Completion thyroidectomy is a safe procedure and may prevent the development of regional recurrence by eliminating an unsuspected focus of cancer.

Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Taskforce

“…Some patients with malignancy may require completion thyroidectomy to provide complete resection of multicentric disease (114), and to allow radioiodine therapy. Most (115,116) but not all (114) studies of papillary cancer have observed a higher rate of cancer in the opposite lobe when multifocal (Ն 2 foci), as opposed to unifocal, disease is present in the ipsilateral lobe. The surgical risks of two-stage thyroidectomy (lobectomy followed by completion thyroidectomy) are similar to those of a near-total or total thyroidectomy (117,118).…”

Multicentricidade no carcinoma diferenciado da tireóide

“…Most of the series studied have advocated total thyroidectomy for the surgical treatment of the thyroid differentiated carcinoma, simply because this procedure has advantages, such as: a greater sensitivity regarding the level of thyroglobulin to assess the recurrent disease, especially distant ones; ease of detection and ablation for distant metastasis by radiotherapy; prevent the possibility of residual thyroid differentiated carcinoma to turn anaplastic; and greater survival with a lower rate of recurrence [3][4][5][6][7][8][9][10][11][12][13][14] .…”

“…Some series have shown that the possibility of the patient having residual tumor in the contralateral lobe is variable, from 21 to 62%, when total thyroidectomy is carried out for prophylaxis purposes 6,9,12,15 . De Jong et al Showed an incidence of 43% of contralateral lobe involvement in 100 patients; Kim et al 16 showed an incidence of 31% in 81 patients and Pacini et al 17 , showed an incidence of 44% in 80 patients.…”

“…Some authors believe the reoperation can be associated with a higher morbidity and thus have advocated ablation with radioactive iodine of the remaining thyroid tissue in lieu of completion thyroidectomy 19 . However, this procedure is challenged by many, because it has some disadvantages, such as the need for a high dose of radioactive iodine, long term development of parathyroid adenoma and teratogenicity in young women in their reproductive years 6,[20][21][22] . Thus, thyroidectomy completion has, once more, its importance and, if carried out by a competent team, carries low morbidity.…”

“…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.…”