Total thyroidectomy vs completion thyroidectomy for thyroid nodules with indeterminate cytology/follicular proliferation: a single-centre experience

Abstract

Background Despite total thyroidectomy (TT) is the most practiced procedure for a preoperatively diagnosed neoplastic lesion, according to the ATA guidelines, many surgeons perform completion thyroidectomy (CT) after hemithyroidectomy for patients with preoperative follicular proliferation/indeterminate cytology who are diagnosed with malignancy. CT has a higher complication rate than the primary procedure. The primary endpoint of our study is to compare the morbidity rate after CT with that after primary TT in patients with follicular proliferation/indeterminate cytology. Methods We retrospectively reviewed 237 patients who underwent thyroid surgery from 2009 to 2018 at our institution. We recruited only patients with follicular proliferation/indeterminate cytology and excluded those undergoing lymphadenectomies and thyroidectomies for benign pathology and staged thyroidectomies after intraoperative documentation of a RLN lesion. One hundred eighty-six of these patients underwent TT, and fifty-one underwent CT for the detection of differentiated thyroid cancer at the histological exam. Results No differences were found in the total complication rates between the two groups (OR 0,76, 95% CI 0.35–1.65, P = 0.49). We did not find any significant differences in the subgroup analysis. In particular, no significant differences were identified for transient hypocalcaemia (OR 1.17, 95% CI 0.44–3.11; P = 0,74), permanent hypocalcaemia (OR 1.04, 95% CI 0.21–5.18; P = 0,95), transient unilateral recurrent laryngeal nerve palsy (OR 0.78, 95% CI 0.21–2.81; P = 0,16), permanent unilateral recurrent laryngeal nerve palsy (OR 1.48, 95% CI 0.28–7.85; P = 0,61), and haematoma (OR 1,84, 95% CI 0,16-20,71; P = 0,61). Conclusions CT following hemithyroidectomy can be performed with acceptable morbidity in patients with thyroid nodules with preoperative indeterminate cytology/follicular proliferation.

Perioperative diagnostics of patients referred for radioiodine therapy of differentiated thyroid carcinoma: referral center experience in an iodine-insufficient country

“…Therefore, it is not clear how many patients, if any, could have e.g., been spared a two-step thyroidectomy. Although some newer studies retrospectively reviewing surgery show that there were no significant differences in the risk of hypocalcaemia (transient and permanent), unilateral recurrent laryngeal nerve palsy (transient and permanent) and/or hematoma after a second completion thyroidectomy compared to a one-step procedure [ 10 , 11 ], general surgical and anesthesia risks can still be minimized by aiming to perform a one-step approach. Still, the issue of frozen section is subject to debate and some international guidelines no longer advocate its routine use [ 12 ].…”

Risk of Complications in Patients Undergoing Completion Thyroidectomy after Hemithyroidectomy for Thyroid Nodule with Indeterminate Cytology: An Italian Multicentre Retrospective Study

“…There is still controversy as to whether patients undergoing a completion thyroidectomy for this reason have a comparable, increased or decreased risk of complications compared to those submitted to primary thyroid surgery [16][17][18][19][20][21][22].…”

Case for staged thyroidectomy

“…6 Many studies have shown that the risk of surgical complications after completion thyroidectomy is not higher than after initial total thyroidectomy. [7][8][9][10] For papillary thyroid carcinoma (PTC), trends have changed with regard to how much thyroid tissue should be removed in the initial surgery. For example, Hirshoren et al found that upfront total thyroidectomy was performed in the majority of patients (61%) prior to the 2015 American Thyroid Association revised guidelines compared to only 31% following these recommendations.…”

“…In these cases, serum thyroglobulin has less sensitivity when compared with patients without thyroid remnant tissue 6 . Many studies have shown that the risk of surgical complications after completion thyroidectomy is not higher than after initial total thyroidectomy 7‐10 …”