Although there is considerable controversy concerning the most appropriate treatment for patients with differentiated thyroid cancer, total thyroidectomy has been thought to offer the best opportunity for long-term disease-free survival. But many
surgeons have been reluctant to perform total thyroidectomy because of the increased risk of permanent hypoparathyroidism. The thoroughness of thyroid resection in so-called total thyroidectomy has been questioned because significant functioning
thyroid
tissue may be left after total thyroidectomy.
In this study, the authors have analysed 54 patients with differentiated thyroid cancer who underwent total or near-total thyroidectomy followed by low-dose(30 mCi) 131I ablation. The purpose of this study was to examine the safety of total and
near-total thyroidectomy, and to evaluate the residual thyroid tissue which was left after total thyroidectomy and the effect of low-dose 131I ablation.
37 patients(685%) had papillary carcinoma, 14 patients had follicular carcinoma, and 3 patients had medullary carcinoma. 47 patients underwent total thyroidectomy, and 7 patients underwent near-total thyroidectomy. Modified neck dissection was
performed
in 32 patients, and central compartmental neck dissection in 22 patients.
Surgical complications developed in 9 patients, which include 6 cases of transient hypoparathyroidism, 1 case of transient unilateral recurrent laryngeal nerve palsy, and 2 cases of wound bleeding. There was no permanent complications.
Of 45 patients who underwent total thyroidectomy, postoperative 131I scan showed uptakes of 131I around thyroid bed in 33 patients(73.3%). Postoperative radioactive iodine uptake(RAIU) in thyroid bed ranged from 1.13% to 5.32%(mean 2.72%) after
total
thyroidectomy, which decreased to 0.01~1.59%(mean 0.25%) after 30 mCi 131I ablation. After near-total thyroidectomy and 30mCi 131I ablation, RAIU ranged from 0.26% to 1.34%(mean 0.31%) In 95% of patients who underwent total thyroidectomy, and 7
patients
underwent near-total thyroidectomy. Modified neck dissection was performed in 32 patients, and central compartmental neck dissection in 22 patients.
Surgical comp9lications developed in 9 patients, which include 6 cases of transient hypoparathyroidism, 1 case of transient unilateral recurrent laryngeal nerve palsy, and 2 cases of wound bleeding. There was no permanent complications.
Of 45 patients who underwent total thyroidectomy, postoperative 131I scan showed uptakes of 131I around thyroid bed in 33 patients(73.3%). Postoperative radioactive iodine uptake(RAIU) in thyroid bed ranged from 1.13% to 5.32%(mean 2.72%) after
total
thyroidectomy, which decreased to 0.01~1.59% (mean 0.25%) after 30mCi 131I ablation. After near-total thyroidectomy and 30mCi 131I ablation. RAIU ranged from 0.26% to 1.34(mean 0.31%). In 95% of patients who underwent total./near-total
thyroidectomy and
low-dose 131I ablation, RAIU was less than 1.5%.
During the 10~104 months of follow-up, serum thyroglobulin level was less than 10ng/ml in all patients except 3 with tumor recurrence, in whom serum thyroglobulin level increased to 19ng/ml, 36.6ng/ml, and 59.7ng/ml.
Total thyroidectomy could be done with minimal permanent morbidity. There were significant residual thyroid tissues in 73.3% of patients after total thyroidectomy, which could be extirpated by low-dose(30 mCi) 131Iodine ablation.
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