Recurrence after Total Thyroidectomy for Benign Multinodular Goiter
Department of Endocrine and Oncology Surgery, University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital, St Leonards, 2065, Sydney, NSW, Australia. World Journal of Surgery
(Impact Factor: 2.64).
04/2007; 31(3):593-8; discussion 599-600. DOI: 10.1007/s00268-006-0135-0
Total thyroidectomy is now the preferred option for the management of benign multinodular goiter (BMNG), and it ought not be associated with recurrent disease. The aim of the present study was to examine the efficacy of total thyroidectomy for BMNG and to review reasons for recurrence.
The study group comprised all patients from January 1980 to December 2005 who underwent a definitive procedure to remove all thyroid tissue for BMNG, and who were subsequently identified as having developed a recurrence. Included were patients who underwent primary total thyroidectomy at our unit, or a two or more stage procedure where a definitive secondary total thyroidectomy was performed at our unit.
There were 3,044 total or secondary total thyroidectomies performed for BMNG during the study period. Ten patients were identified as having developed recurrent BMNG requiring reoperation despite previous complete "total" thyroidectomy. There were 11 sites of recurrence in 10 patients. Only one was a true local recurrence in the thyroid bed. Another 9 recurrences related to the embryology of the thyroid gland, 4 in the pyramidal tract and 5 in the thyrothymic tract. There was one recurrence at another site (submandibular) in a patient with presumed metastatic thyroid cancer despite benign histology. There were no complications in any of the 10 patients.
Total thyroidectomy for BMNG is not only a safe procedure but is efficacious in preventing recurrent disease. Failure to remove embryological remnants such as thyrothymic residue or pyramidal remnants during total thyroidectomy is the major cause of recurrence.
Available from: Gianfranco Fenzi
- "Thus, the most important result of the combined analysis of the two markers is the reduction of false-negative cases. Total thyroidectomy is the operation of choice for multinodular goiter for the majority of endocrine surgeons (Hisham et al. 2001, Snook et al. 2007). Thus, total thyroidectomy is recommended for a suspicious nodule in multinodular goiter. "
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ABSTRACT: Ten to fifteen percent of fine-needle aspiration biopsy (FNAB) of thyroid nodules are indeterminate. Galectin-3 (Gal-3) and the oncogene BRAFV600E are markers of malignancy useful to improve FNAB accuracy. The objective of this study was to determine whether the combined analysis of Gal-3 and BRAFV600E expression in thyroid aspirates could improve the diagnosis in FNAB with suspicious cytological findings. Two hundred and sixty-one surgical thyroid tissues and one hundred and forty-four thyroid aspirates were analyzed for the presence of the two markers. In surgical specimens, Gal-3 expression was present in 27.4% benign nodules, 91.9% papillary (PTC) and 75% follicular (FTC) thyroid carcinomas. BRAFV600E was not detected in 127 benign nodules, as well as in 32 FTCs, while was found in 42.9% PTC. No correlation was found between BRAF mutation and Gal-3 expression. Forty-seven consecutive FNAB suspicious for PTC were analyzed for the presence of the two markers. Of these nodules, 23 were benign at histology, 6 were positive for Gal-3, none displayed BRAFV600E, and 17 were negative for both the markers. Twenty suspicious nodules were diagnosed as PTC and four FTCs at histology. Of these 24 carcinomas, 9 resulted positive for BRAFV600E, 17 for Gal-3, and 22 for one or both the markers. The sensitivity, specificity, and accuracy for the presence of Gal-3 and/or BRAFV600E were significantly higher than those obtained for the two markers alone. Notably, the negative predictive value increased from 70.8 to 89.5%. In conclusion, the combined detection of Gal-3 and BRAFV600E improves the diagnosis in FNAB with cytological findings suspicious for PTC and finds clinical application in selected cases.
Available from: dicle.edu.tr
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ABSTRACT: Surgical treatment of benign nodular goiter; report of 72 patients Surgical resection is usually prefered for the treatment of benign nodular goiter. But the extention of thyroidectomy in the surgical management of benign nodular goiter still remains controversial. Seventytwo patients underwent thyroid surgery between April 2002- July2007 in Kõzõltepe State Hospital Otorhinolaryngology Service. Of the patients 63 were women (%87.5), 9 were man (%12.5). The range of age was between 15-62 years and mean age was 36,5. Thirtynine patients had unilateral total lobectomy+ istmusectomy (%54.2), 11 patients had unilateral lobectomy+ isthmusectomy+contralateral subtotal lobectomy (Dunhill Procedure) (%15.3), 20 patients had nearly total thyroidectomy (%27.8), 2 patients had total thyroidectomy (% 2.7). Three patients had seroma (%4.1), 2 patients had hemorrhage requiring operative hemostasis (%2.7), 1 patient had suture reaction(%1.3). Patients have not had permanent or temporary nervus laryngeus recurrens injury, hypoparathyroidism and infection. As a result more extent surgical resections must be preferred by the surgeon for the treatment of benign nodular goiter. The preferable surgical treatment of solitary nodules is lobectomy+isthmusectomy. The multinodular goiter must be treated with unilateral lobectomy+ isthmusectomy+contralateral subtotal lobectomy (Dunhill procedure) when the remnant thyroid tissue is normal; otherwise nearly total or total thyroidectomy is preferable.
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ABSTRACT: To determine the significance of Delphian lymph node (DLN) involvement in thyroid cancer.
The DLN has long been regarded as a predictor of thyroid malignancy and indicator of advanced disease; however, there are no published data in relation to the thyroid.
A retrospective cohort study with data obtained from the University of Sydney Endocrine Surgery database and histopathology records. The study cohort comprised 1000 consecutive patients undergoing total thyroidectomy.
The DLN was separately removed and identified as such in 263 of 1000 (26.3%) patients. Of 1000 patients 203 (20.3%) had a diagnosis of papillary/medullary cancer. Of this group 150 patients had surgery performed for suspected cancer, and in 53 the diagnosis of cancer was unsuspected. In only 1 case did the DLN operative appearance alert the surgeon to an otherwise unsuspected thyroid cancer. The DLN was separately identified in 103 patients with cancer and, in this group, 22 of 103 (21.4%) had DLN metastases. DLN involvement was associated with greater nodal disease (9.8 vs. 1.6 nodes; P < 0.001), larger tumor size (19.4 vs. 11.1 mm; P < 0.003) and younger age (41 vs. 47 years; P = 0.058). DLN involvement was highly predictive of further disease in the central compartment (sensitivity = 41%, specificity = 95%), moderately predictive of further disease in the lateral compartment (sensitivity = 50%, specificity = 88%), and strongly suggestive of further nodal disease in the neck (sensitivity = 64%, specificity = 100%).
Although the clinical appearance of the DLN is not an accurate indicator of the presence of unsuspected thyroid cancer, metastatic involvement of the DLN is an adverse prognostic marker in papillary/medullary thyroid cancer. The presence of DLN metastasis in patients with thyroid cancer should alert the surgeon to the high probability of advanced disease and need for greater attention to the central and lateral lymph node compartments.
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