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Indian Journal of Surgery

, Volume 81, Issue 1, pp 23–27 | Cite as

Completion Thyroidectomy for Differentiated Thyroid Cancers: Predicting Contralateral Disease

  • Ranganath RatnagiriEmail author
  • Megha Uppin
  • Shubhranshu Jena
  • Rajashekhar S. Patil
  • G. S. N. Raju
Original Article
  • 47 Downloads

Abstract

About 12% of the Indian population present with a thyroid nodule to the surgeon, who is then faced with a clinical dilemma if the fine needle aspiration cytology (FNAC) is inconclusive or indeterminate, and the ultrasonogram of the neck is also not contributory. The extent of surgery and the need for a second surgery always weighs on the mind of the surgeon and the patient. We attempt, in our study, to identify a few pathological features in a hemithyroidectomy specimen which would predict the occurrence of malignancy in the opposite lobe. To determine the pathologic predictors of malignancy in the contralateral thyroid lobe, in patients of differentiated thyroid cancer (DTC) who underwent hemithyroidectomy. A retrospective review of the case records of all patients who underwent thyroid surgery in our Institute between January 2010 and December 2014 was undertaken. Various pathologic parameters were analyzed with respect to their predictive power regarding the occurrence of malignancy in the opposite lobe. Three hundred eighty-nine patients underwent thyroid surgery during the above period, of which 91 patients underwent completion thyroidectomy, as they were found to have malignancy in the hemithyroidectomy specimen. The effect of age, gender, and tumor size on bilaterality could not be established statistically. Other variables such as perithyroidal spread and perineural invasion also did not demonstrate statistical significance. Multifocality of the tumor in the hemithyroidectomy specimen, lymphovascular invasion, and capsular invasion were the pathologically significant factors determining the presence of malignancy in the contralateral lobe. Multifocality, lymphovascular invasion, and capsular invasion can be used as additional markers to decide on performing a completion thyroidectomy in a patient of differentiated thyroid cancer.

Keywords

Completion thyroidectomy Differentiated thyroid cancer Tall cell variant Multifocality Capsular invasion Lymphovascular invasion 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have conflict of interest.

References

  1. 1.
    GLOBOCAN (2012) Estimated cancer incidence, mortality and prevalence worldwide. IARC 2012Google Scholar
  2. 2.
    Brito JP, Yarur AJ, Prokop LJ, Mc Iver B, Murad MH, Montori VM (2013) Prevalence of thyroid cancer in multinodular goiter versus single nodule: a systematic review and meta- analysis. Thyroid 23(4):449–455.  https://doi.org/10.1089/thy.2012.0156 CrossRefGoogle Scholar
  3. 3.
    Cooper DS, Doherty GM, Haagen BR, Kloos RT, Lee SL, Manuel SJ et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19(11):1167–1214.  https://doi.org/10.1089/thy.2009.0110 CrossRefGoogle Scholar
  4. 4.
    Castro MR, Espiritu RP, Bahn RS, Henry MR, Gharib H, Caracalla PJ (2011) Predictors of malignancy in patients with cytologically suspicious thyroid nodules. Thyroid 21(11):1191–1198.  https://doi.org/10.1089/thy.2011.0146 CrossRefGoogle Scholar
  5. 5.
    Pasieka JL, Thompson NW, Mc Leod MK, Burney RE, Mocha M (1992) The incidence of well differentiated thyroid cancer found at completion thyroidectomy. World J Surg 16(4):711–716.  https://doi.org/10.1007/BF02067365 CrossRefGoogle Scholar
  6. 6.
    Kim ES, Kim TY, Koh JM, Yi K, Hong SJ, Kim WB (2004) Completion thyroidectomy in patients with thyroid cancer who initially underwent unilateral operation. Clin Endocrinol 61(1):145–148.  https://doi.org/10.1111/j.1365-2265.2004.02065.x CrossRefGoogle Scholar
  7. 7.
    Pitt SC, Sippel RS, Chen H (2009) Contralateral papillary thyroid cancer: does size matter? Am J Surg 197(3):342–347.  https://doi.org/10.1016/j.amjsurg.2008.09.011 CrossRefGoogle Scholar
  8. 8.
    Pacino F, Elisei R, Capezzone M, Miccoli P, Molinaro E (2001) Contralateral papillary thyroid cancer is frequent at completion thyroidectomy with no difference in low and high risk patients. Thyroid 11(9):877–881.  https://doi.org/10.1089/105072501316973145 CrossRefGoogle Scholar
  9. 9.
    Barczynski M (2012) Completion thyroidectomy for well differentiated thyroid cancer. Thyroid Disord Therapy 1:2CrossRefGoogle Scholar
  10. 10.
    Erdem E, Gulcelik MA, Kuru B, Alagol H (2003) Comparison of completion thyroidectomy and primary surgery for differentiated thyroid carcinom. Eur J Surg Oncol 29(9):747–749.  https://doi.org/10.1016/j.ejso.2003.08.006 CrossRefGoogle Scholar
  11. 11.
    Mendelssohn AH, Elashoff DA, Abemayor E, St John MA (2010) Surgery for papillary thyroid carcinoma: is lobectomy enough? Arch Otolaryngol Head Neck Surg 136(11):1055–1061.  https://doi.org/10.1001/archoto.2010.181 CrossRefGoogle Scholar
  12. 12.
    Kazaure H, Ranan S, Sosa J (2012) Aggressive variants of papillary thyroid cancer: incidence, characteristics and predictors of survival among 43,738 patients. Ann Surg Oncol 19(6):1874–1880.  https://doi.org/10.1245/s10434-011-2129-x CrossRefGoogle Scholar
  13. 13.
    Connor MP, Wells D, Schmalbach CE (2011) Variables predictive of bilateral occult papillary microcarcinoma following total thyroidectomy. Otolaryngol Head Neck Surg 144(2):210–215.  https://doi.org/10.1177/0194599810391616 CrossRefGoogle Scholar
  14. 14.
    Ibrahim B, Forest V-I, Hier M, Mlyarek AM, Caglar D, Payne RJ (2015) Completion thyroidectomy: predicting bilateral disease. J Otolaryngol Head Neck Surg 44(1):23.  https://doi.org/10.1186/s40463-015-0076-4 CrossRefGoogle Scholar
  15. 15.
    Reeve TS, Delbridge L, Brady P, Cramer P, Smyth C (1988) Secondary thyroidectomy: a twenty year experience. World J Surg 12(4):449–453.  https://doi.org/10.1007/BF01655417 CrossRefGoogle Scholar
  16. 16.
    Rico JA, Alfonso AE (2012) Multifocal micropapillary thyroid cancer: a new indication for total thyroidectomy? Ann Surg 78(11):1211–1214Google Scholar
  17. 17.
    Turanli S, Asian S, Cetin A (2011) Clinical significance of residual occult malignancy in thyroid carcinoma. Am J Otolaryngol 32(5):398–401.  https://doi.org/10.1016/j.amjoto.2009.12.005 CrossRefGoogle Scholar
  18. 18.
    Lodewijk L, Kluijfhout WP, Kist J, Stegeman I, Plukker J, Bonner J (2016) Characteristics of contralateral carcinomas in patients with differentiated thyroid cancers larger than 1 cm. Langenbeck's Arch Surg 401(3):365–373.  https://doi.org/10.1007/s00423-016-1393-4 CrossRefGoogle Scholar
  19. 19.
    Kumar GK, Syed N, Nemade H, Pawar S (2016) Safety of completion thyroidectomy for initially misdiagnosed thyroid carcinoma. Rambam maimonides Medical Journal 7:3Google Scholar
  20. 20.
    Mishra A, Agarwal A, Agarwal G, Mishra SK (2001) Total thyroidectomy for benign thyroid disorders in an endemic region. World J Surg 25(3):307–310.  https://doi.org/10.1007/s002680020100 CrossRefGoogle Scholar

Copyright information

© Association of Surgeons of India 2017

Authors and Affiliations

  • Ranganath Ratnagiri
    • 1
    Email author
  • Megha Uppin
    • 2
  • Shubhranshu Jena
    • 1
  • Rajashekhar S. Patil
    • 1
  • G. S. N. Raju
    • 1
  1. 1.Department of Surgical OncologyNIMSHyderabadIndia
  2. 2.Department of PathologyNIMSHyderabadIndia

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