The Advantage of Total Thyroidectomy to Avoid Reoperation for Incidental Thyroid Cancer in Multinodular Goiter

Abstract

Hypothesis: To investigate the impact of total thyroidectomy on the rate of completion thyroidectomy for incidentally found thyroid cancer in euthyroid multinodular goiter. Design: A randomized, prospective clinical trial. Setting: A tertiary referral center. Patients: Patients with euthyroid multinodular goiter without any preoperative suspicion of malignancy, history of familial thyroid cancer, or previous exposure to radiation were randomized (according to a random table) to total or near-total thyroidectomy leaving no remnant tissue or less than 1 g (group 1; n = 109) or bilateral subtotal thyroidectomy leaving 5 g or more of remnant tissue (group 2; n = 109). Patients with preoperative or perioperative suspicion of malignancy were excluded. Main Outcome Measures: We compared the complication rates and the incidence of thyroid cancer requiring radioactive iodine ablation and completion thyroidectomy between groups. Results: There were no permanent complications. The rates of temporary unilateral vocal cord dysfunction and hypoparathyroidism showed no significant difference between groups 1 and 2 (0.9% vs 0.9% and 1.8% vs 0.9%, respectively; PϾ.05). Papillary cancer was found in 10 group 1 patients (9.2%) and 8 group 2 patients (7.3%) (P=.80). Of the 9 patients requiring radioactive iodine ablation, reoperation was avoided in 5 group 1 patients; the remaining 4 group 2 patients underwent completion thyroidectomy (P =.007). Conclusion: We recommend total or near-total thyroidectomy in multinodular goiter to eliminate the necessity for early completion thyroidectomy in case of a final diagnosis of thyroid cancer.

Incidental thyroid carcinomas. A retrospective study

“…Our experience only partly confirms the literature on multifocality and bilaterality as the percentage of multifocality was lower (15.66%), albeit slightly, compared with that reported by other authors, and only in 7,23% we observed bilaterality of neoplastic lesions. However, the data resulting from postoperative scintigraphic controls (57.69% of lymph node metastasis detected) gives us the validation of our approach and some authors agree with us (23,(79)(80)(81)(82). On the contrary some Authors do not share this setting (83)(84)(85)(86)(87)(88)(89)(90)(91) and others suggest a stratification of the risk of recurrence based on the presence of BRAF mutation, extrathyroidal extension, lateral neck lymph node metastases, multifocality, TSH levels, molecular markers, high metabolic tumor volume and tumor stage (92)(93)(94)(95)(96)(97)(98)(99)(100)(101)(102).…”

Less than total thyroidectomy for goiter: when and how?

“…On the contrary, based on results of two prospective trials, incidental cancers may be rare and no carcinoma may be discovered at all (12,47). Nevertheless, in a study by Giles and colleagues, the need for a completion thyroidectomy was as low as 3.5% of bilateral multinodular goiter patients (48). This was similar to the rate of completion thyroidectomy after bilateral subtotal surgery (3.68%) reported in another randomized controlled study (49).…”

Retrospective Analysis of Thyroidectomy Cases That Became Subjects Due to Unintended Consequences

“…36 Reoperasyonlarda kalıcı RLS hasarı ve kalıcı hipoparatiroidi oranları ilk operasyona kıyasla 2-10 kat artmaktadır. 8,13,17,30,42 Fibröz dokunun infiltrasyonu sonucunda normal anatomik yapılar değişim gösterdiğinden komplikasyonlara açık hâle gelmekte, bu durum da nüks tiroid patolojilerinin tekrar ameliyatını daha güç kılmaktadır. 39 Yara enfeksiyonu ve kanama oranları da nüks guatrlar için yapılan ameliyatlarda artmaktadır.…”