SAFETY AND EFFICACY OF TOTAL THYROIDECTOMY FOR DIFFERENTIATED THYROID-CARCINOMA - A 20-YEAR REVIEW

Controversy continues to exist regarding the optimal extent of resecti on for differentiated thyroid carcinoma (DTC). Subtotal thyroidectomy has been advocated by some authors in expectation of lower complicatio n rates, while others advocate total thyroidectomy to achieve better c ure rates. To examine this issue, the medical records of 124 patients who underwent total thyroidectomy for DTC were retrospectively reviewe d. Total thyroidectomy was the initial procedure in 115 patients, whil e nine patients had complete thyroidectomy following some type of subt otal resection. Concomitant procedures were performed in 47 patients. Ninety papillary, 20 mixed papillary-follicular variant, one Hurthle c ell type, and 13 follicular carcinomas were performed. Tumors were bil ateral or multicentric in 40 patients, with metastases present in one- third of patients at the same time of initial operation. Permanent hyp oparathyroidism developed in two patients, and permanent ipsilateral r ecurrent laryngeal nerve palsy occurred in one patient, for an overall significant complication rate of 2.4 per cent. Tumor recurrence was n oted at a mean of 19 months postoperatively in 14 patients. Ninety-six patients received adjuvant postoperative radioiodine therapy to ablat e residual functioning thyroid tissue or suspected metastases. We conc lude that total thyroidectomy as treatment for differentiated thyroid carcinoma carries a low rate of morbidity, treats occult contralateral disease, and should facilitate radioiodine scanning and ablation of r esidual functioning thyroid tissue or metastatic disease.