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

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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<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.

Résumé

Le but de cette étude était d'évaluer l'évolution chirurgicale après thyroïdectomie totale des patients ayant un cancer thyroïdien présumé bien différencié et unilatéral (CTBD). Les données médicales de tous les patients ayant eu une lobectomie unilatérale de la thyroïde pour CTBD et qui ont eu secondairement une totalisation de la thyroïdectomie ont été revues. Entre 1980 et 1991, 60 patients ayant un CTBD ont eu une totalisation de la thyroïdectomie, quarante sept avaient un CTBD présumé unilatéral, sans argument pour une pathologie résiduelle avant la totalisation de la thyroïdectomie (groupe 1). Vingt cinq d'entre eux (53%) se sont avérés avoir un reliquat néoplasique persistant au niveau de la région cervicale. Chez 20/47 (43%) patients, on a retrouvé un foyer de cancer dans le lobe restant de la thyroïde. Chez 5 patients supplémentaires il n'a pas été retrouvé de cancer dans le lobe controlatéral mais une dystrophie nodulaire non suspecte. Les 13/60 patients restants présentaient soit une récidive régionale (12) soit des métastases à distance (1) au moment de la totalisation de la thyroïdectomie (groupe 2). Tous les patients du groupe 2 sauf un (92%) avaient un cancer dans le lobe restant. Une atteinte plurifocale dans le premier lobe était associée avec l'existence d'un cancer bilatéral (p<0.01). Les complications ont été rares: une hypocalcémie transitoire est survenue chez 5 (8%) patients, une hypoparathyroïdie définitive est apparue chez 1 (1.7%) patient. Une paralysie récurentielle transitoire a été retrouvée chez 3 (5%) patients. Conclusions: Un reliquat de TCBD a été retrouvé chez 37/60 (62%) patients opérés d'une totalisation de thyroïdectomie. L'atteinte multifocale dans le premier lobe réséqué était associée avec une incidence élevée de cancer thyroïdien controlatéral. La totalisation de la thyroïdectomie est une procédure sans risque qui peut prévenir le développement d'une récidive régionale en éliminant un foyer de cancer non suspecté.

Resumen

El propósito del presente estudio fue valorar el resultado quirúrgico de completar a una tiroidectomía total la resección tiroidea realizada en pacientes con cáncer presumiblemente unilateral y bien diferenciado de la glándula tiroides (CTBD). Se revisaron las historias clínicas de todos los pacientes sometidos a lobectomía tiroidea unilateral por CTBD, en quienes subsiguientemente se completó la tiroidectomía, procedimiento que fue realizado en 60 pacientes con CTBD en el período 1980–1991. Cuarenta y siete pacientes tenían CTBD presumiblemente unilateral, sin evidencia de enfermedad residual antes de completarse la tiroidectomía (grupo 1); en veinticinco (53%) de estos pacientes se halló neoplasia residual en el cuello. En 20/47 (43%) pacientes se encontró un foco de cáncer en el lóbulo tiroideo remanente y en 5 casos adicionales aunque no se encontró cáncer en el lóbulo contralateral, se halló extensión ganglionar no sospechada. Los 13/60 pacientes restantes presentaron recurrencia (12) o metástasis distantes (1) en el momento de completarse la tiroidectomía (grupo 2). Todos los pacientes del grupo 2, excepto 1 (92%), presentaban cáncer en el lóbulo remanente. La presencia de enfermedad multifocal en el lóbulo primario apareció asociada con cáncer tiroideo bilateral (p<0.01). Las complicaciones fueron raras; se presentó hipocalcemia transitoria en 5 (8%) pacientes, hipotiroidismo permanente en 1 (1.7%) y parálisis parcial y transitoria del nervio laríngeo recurrente en 3 (5%). Conclusiones: Se encontró CTBD en 37/60 (62%) pacientes en quienes se completó la tiroidectomía. La presencia de enfermedad multifocal en el lóbulo primario resecado apareció asociada con una alta incidencia de cáncer contralateral. El procedimiento de completar la tiroidectomía aparece como una operación segura que puede prevenir el desarrollo recurrencia regional al eliminar focos insospechados de cáncer.

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Authors and Affiliations

  1. Department of Surgery, Division of Endocrine Surgery, University of Michigan, Ann Arbor, Michigan, U.S.A.

    Janice L. Pasieka M.D. (F.R.C.S.C.), Norman W. Thompson M.D. (F.A.C.S.), Michael K. McLeod M.D. (F.A.C.S.), Richard E. Burney M.D. (F.A.C.S.) & Mahender Macha

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  1. Janice L. Pasieka M.D.
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  2. Norman W. Thompson M.D.
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  5. Mahender Macha
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Pasieka, J.L., Thompson, N.W., McLeod, M.K. et al. The incidence of bilateral well-differentiated thyroid cancer found at completion thyroidectomy. World J. Surg. 16, 711–716 (1992). https://doi.org/10.1007/BF02067365

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