Recurrence after conservative thyroid surgery ranges from 7 to 40%. Risk factors for recurrence are female sex, multiple nodules in the resected lobe and lack of postoperative LT4 therapy. Indications for reoperation are suspected malignancy, recurrent thyrotoxicosis and recurrent uninodular or multinodulare goitre. From 2002 to 2008, 2149 total thyroidectomies were performed. Ninety-two patients had a completion thyroidectomy. The indication was recurrent multinodular goitre in 81, recurrent thyrotoxicosis in 3, and suspected malignancy in 8. Bilateral completion thyroidectomy was performed in 63 cases, lobectomy in 27 cases, removal of a mediastinal recurrence in 1 case and removal of a pyramidal remnant in 1 case. Histological examination revealed papillary cancer in 18 patients and follicular cancer in 1. Mean operative time was 140 minutes (range: 60-260). All patients were submitted to a minimum follow-up of 6 months. Temporary hypoparathyroidism occurred in 36 patients (39.1%) and definitive hypoparathyroidism in 7 patients (7.6%). Transient recurrent laryngeal nerve palsy occurred in 3 cases (3.2%) and permanent nerve palsy in 1 (1.1%). In 3 cases (3.2%) surgical revision of haemostasis was necessary for postoperative haemorrhage. Total thyroidectomy is the treatment of choice in multinodular goitre. In the cases in which reoperation is necessary, the intervention must be performed by an experienced surgeon.
Recurrence after conservative thyroid surgery ranges from 7 to 40%. Risk factors for recurrence are female sex, multiple nodules in the resected lobe and lack of postoperative LT4 therapy. Indications for reoperation are suspected malignancy, recurrent thyrotoxicosis and recurrent uninodular or multinodulare goitre. From 2002 to 2008, 2149 total thyroidectomies were performed. Ninety-two patients had a completion thyroidectomy. The indication was recurrent multinodular goitre in 81, recurrent thyrotoxicosis in 3, and suspected malignancy in 8. Bilateral completion thyroidectomy was performed in 63 cases, lobectomy in 27 cases, removal of a mediastinal recurrence in 1 case and removal of a pyramidal remnant in 1 case. Histological examination revealed papillary cancer in 18 patients and follicular cancer in 1. Mean operative time was 140 minutes (range: 60-260). All patients were submitted to a minimum follow-up of 6 months. Temporary hypoparathyroidism occurred in 36 patients (39.1%) and definitive hypoparathyroidism in 7 patients (7.6%). Transient recurrent laryngeal nerve palsy occurred in 3 cases (3.2%) and permanent nerve palsy in 1 (1.1%). In 3 cases (3.2%) surgical revision of haemostasis was necessary for postoperative haemorrhage. Total thyroidectomy is the treatment of choice in multinodular goitre. In the cases in which reoperation is necessary, the intervention must be performed by an experienced surgeon.
Recurrent goitre: our experience [Il gozzo recidivo. Nostra esperienza]
Calo P. G.;Pisano G.;Medas F.;Nicolosi A.
2009-01-01
Abstract
Recurrence after conservative thyroid surgery ranges from 7 to 40%. Risk factors for recurrence are female sex, multiple nodules in the resected lobe and lack of postoperative LT4 therapy. Indications for reoperation are suspected malignancy, recurrent thyrotoxicosis and recurrent uninodular or multinodulare goitre. From 2002 to 2008, 2149 total thyroidectomies were performed. Ninety-two patients had a completion thyroidectomy. The indication was recurrent multinodular goitre in 81, recurrent thyrotoxicosis in 3, and suspected malignancy in 8. Bilateral completion thyroidectomy was performed in 63 cases, lobectomy in 27 cases, removal of a mediastinal recurrence in 1 case and removal of a pyramidal remnant in 1 case. Histological examination revealed papillary cancer in 18 patients and follicular cancer in 1. Mean operative time was 140 minutes (range: 60-260). All patients were submitted to a minimum follow-up of 6 months. Temporary hypoparathyroidism occurred in 36 patients (39.1%) and definitive hypoparathyroidism in 7 patients (7.6%). Transient recurrent laryngeal nerve palsy occurred in 3 cases (3.2%) and permanent nerve palsy in 1 (1.1%). In 3 cases (3.2%) surgical revision of haemostasis was necessary for postoperative haemorrhage. Total thyroidectomy is the treatment of choice in multinodular goitre. In the cases in which reoperation is necessary, the intervention must be performed by an experienced surgeon.
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