Re-operation for the treatment of well differentiated thyroid cancer: necessity, safety and impaction on further management.

BACKGROUND The diagnosis of thyroid carcinoma during the course of lobectomy for a dominant nodule occasionally cannot be rendered on the basis of frozen section. Once the diagnosis of carcinoma is made, the question of completion thyroidectomy arises. PATIENTS AND METHODS During a period of 3 years, 28 patients diagnosed with well-differentiated thyroid cancer (WDTC), and operated upon with less than total thyroidectomy, were admitted to our department. Patients had no clinical or radiological evidence of any residual disease at the time of admission. All were submitted for total thyroidectomy. RESULTS There were 7 men and 21 women (1:3), and the average age was 38.6+/-1.3 years (range, 20 to 62 years). The postoperative morbidity in completion thyroidectomy consisted of transient hypoparathyroidism in 2 patients (7.1 %), permanent hypoparathyroidism in 1 patient (3.5%), there was no recurrent laryngeal nerve palsy, there were haematoma in 2 patients, and seroma in 1 patient. Completion thyroidectomy resulted in detecting 9 patients (32.1%) having residual disease that was not clinically manifest. CONCLUSION Although many surgeons advocate total or near-total thyroidectomy for differentiated thyroid carcinoma, some of these surgeons hesitate to complete thyroidectomy after lobectomy for thyroid nodule when there is no clinical evidence to suggest bilateral disease, for fear of added morbidity to the patients. However, as demonstrated in this study, completion thyroidectomy was shown to be a fairly safe procedure, which carries a low incidence of complications. It also facilitates further management and follow-up with radioactive iodine. The decision to perform completion thyroidectomy for WDTC should be based on the patient's risk category, and not on a concern for risk of complications from the second procedure.