The management of carcinoma of the thyroid varies greatly in different clinics, ranging from partial resection to total thyroidectomy with of without lymph node dissection. However, there has been reluctance to perform total thyroidectomy for
malignant
disease because of the possibility of hypoparathyroidism and recurrent laryngeal nerve injury following this operation. Many reports recently have shown minimal morbidity following total thyroidectomy and recommended its use for all malignant
disease of
the thyroid. We also believe that total thyroidectomy is the treatment of choice in all patients with invasive thyroid carcinoma. In this report we reviewed experiences with 78 consecutive total thyroidectomies performed at one center for thyroid
cancer
during a 8-year period from January 1987 to December 1994.
Among 78 total thyroidectomies, 33 patients underwent only total thyroidectomy and 45 patients underwent total thyroidectomy with neck dissection. The sixty eight postoperative local complications occurred in 55 patients among 78 patients:
postoperative
bleeding in 1(13%), airway obstruction in 1(1.3%), transient recurrent laryngeal nerve palsy in 8(10.3%), permanent unilateral recurrent laryngeal nerve injury in 5(6.4%), transient hypoparathyroidism in 43(55.1%), permanent hypoparathyroidism in
3(3.8%), hematoma in 4(5.1%), seroma in 2(2.5%), and wound infection in 1(1.3%). The most frequent complication was transient hypoparathyroidism and followed by transient recurrent laryngeal nerve palsy. Permanent unilateral recurrent laryngeal
nerve
injury occurred in five patients because recurrent laryngeal nerve was sacrificed for radical resection due to gross tumor invasion. There was no operative mortality, and permanent hypoparathyroidism and unilateral recurrent laryngeal nerve
injury
were
relatively tolerable in affecting patients.
This data suggests that total thyroidectomy is safe procedure with relatively low morbidi-ty, so total thyroidectomy should be considered as the primary treatment for thyroid cancer.
|