Abstract
Reoperative thyroid surgery may be required in patients who undergo any procedure less than total or near total thyroidectomy. The aim of this study was to investigate advantages of gamma-probe guided revision thyroidectomy (GGRT) over conventional revision thyroidectomy (CRT) in patients with differentiated thyroid carcinoma (DTC). GGRT was assessed according to the TSH values, complication rates and the incidence of carcinoma in residual thyroid tissue. In this randomised prospective clinical trial, 25 patients with differentiated thyroid carcinoma who had previously undergone surgery for benign multinodular goiter were included in the study. GGRT was performed in 11 (44%) patients (Group 1 ) and CRT in 14 (65%) (Group 2). The intraoperative mean ratio of thyroid activity to background activity (T/B) was detected as 5.1 ±1.4 and the mean ratio of thyroid bed activity to background activity after excision (Tbed/B) was 1.3±0.3, (p<0.01). Although the incidence of carcinoma in residual thyroid tissue was higher in group 1 (4/11) in comparison to group 2 (1/14), it was not statistically significant. The elevation of the TSH concentration at the first post-operative month was significantly higher in group 1 in comparison with group 2 (18±25 5±3 mIU/l), (p<0.02). These results indicate that intraoperative gamma probe application may be beneficial to detect and remove residual thyroid tissue in revision thyroidectomy.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Acun Z, Cömetr M, Cihan A, Ulukent SC, Ucan B, Çakmak GK. Near-total thyroidectomy could be the best treatment for thyroid disease in endemic regions. Arch Surg 2004, 139: 444–7.
Mishra A, Agarwal A, Agarwal G, Mishra SK. Total thyroidectomy for bening thyroid disorders in an endemic region. World J Surg 2001, 25: 224–8.
Mazzaferri EL, Klaos RT. Clinical Review 128: Current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Met 2001, 86: 1447–63.
Degroot LJ, Kaplan EL. Second operations for ‘completion’ of thyroidectomy in treatment of differentiated thyroid cancer. Surgery 1991, 110: 936–40.
Erdem E, Gülçelik MA, Kuru B, Alagöl H. Comparison of completion thyroidectomy and primary surgery for differentiated thyroid carcinoma. Eur J Surg Oncol 2003, 29: 747–9.
Mariani G, Villa G, Gipponi M, et al. Mapping sentinel lymph node in breast cancer by combined lymphoscintig-rahy, blue-dye, and intraoperative gamma-probe. Cancer Biother Radiopharm 2000, 15: 245–52.
Axel JC, Krag DN, Harlow SP, et al. Localization of regional lymph node in melanomas of head and neck. Arch Otolaryn-gol Head Neck Surg 1998, 124: 135–40.
Rubello D, Piotto A, Pagetta C, Pelizzo MR, Casara D. 99mTcMIBI radio-guided surgery for recurrent thyroid carcinoma: technical feasibility and procedure, and preliminary clinical results. Eur J Nucl Med 2002, 29: 1201–5.
Giles Y, Boztepe H, Terzioglu T, Tezelman S. The advantage of total thyroidectomy to avoid reoperation for incidental thyroid cancer in multinodular goiter. Arch Surg 2004, 139: 179–82.
Pearre EN, Braverman LE. Papillary thyroid carcinoma outcomes and implication for treatment. J Clin Endocrinol Med 2004, 89: 2710–2.
Mishra A, Mishra SK. Total thyroidectomy for differentiated thyroid cancer: primary compared with completion thyroidectomy. EurJ Surg 2002, 168: 283–7.
Grebe SKG, Hay ID. The role of surgery in the management of differentiated thyroid cancer. J Endocrinol Invest 1997, 20: 32–5.
Hay ID, Thompson GB, Grant CS, et al. Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940–1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J Surg 2002, 26: 879–85.
Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy an papillary and follicular cancer. Am J Med 1994, 97: 418–28.
DeGroot LJ, Kaplan EL, McCormick M, Straus FH. Natural history, treatment, and course of papillary thyroid carcinoma. J Clin Endocrinol Med 1990, 71: 414–24.
Reeve TS, Delbridge L, Brady P, Crummer P, Smyth C. Secondary thyroidectomy, a ten years experience. World J Surg 1988, 12: 449–53.
Casara D, Rubello D, Cauzzo C, Pelizzo MR. 99mTc-MIBI radio-guided minimally invasive parathyroidectomy: experience with patients with normal thyroid and nodular goitres. Thyroid 2002, 12: 53–61.
Boz A, ArIcI C, Güngör F, YIldIz A, Çolak T, KarayalçIn B. Gamma probe-guided resection and scanning with 99mTc-MIBI of a local recurrence of follicular thyroid carcinoma. Clin Nucl Med 2001, 26: 820–2.
Salvatori M, Rufini V, Reale F, et al. Radio-guided surgery for lymph node recurrences of differentiated thyroid cancer. World J Surg 2003, 27: 770–5.
Ricard M. Intraoperative detection of radiolabeled compounds using a hand held gamma probe. NIM A 2001, 458: 26–33.
Gulec SA, Eckert M, Woltering EA. Gamma probe-guided lymph node dissection (gamma picking) in differentiated thyroid carcinoma. Clin Nucl Med 2002, 27: 859–61.
Glass EC. Nuclear medicine in the detection of the sentinel node. Ann Surg Oncol 2001, 8: 5–8.
Travagli JP, Cailleux AF, Ricard M, et al. Combination of radioiodine (131I) and probe-guided surgery for persistent or recurrent thyroid carcinoma. J Clin Endocrinol Metab 1998, 83: 2675–80.
Grebe SKG, Hay ID. Thyroid cancer nodal metastases: biologic significance and therapeutic consideration. Surg Oncol Clin North Am 1996, 5: 43–63.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Erbil, Y., Barbaros, U., Deveci, U. et al. Gamma probe-guided surgery for revision thyroidectomy: In comparison with conventional technique. J Endocrinol Invest 28, 583–588 (2005). https://doi.org/10.1007/BF03347255
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03347255