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Radioactive Iodine Remnant Uptake After Completion Thyroidectomy: Not Such a Complete Cancer Operation

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Given limitations in preoperative diagnostics, thyroid lobectomy followed by completion thyroidectomy (CT) for differentiated thyroid cancer (DTC) may be required. It is unclear whether resection quality by CT differs from that by total thyroidectomy (TT). Additional surgeon or patient factors may also influence the “completeness” of resection. This study evaluated how CT and surgeon volume influence the adequacy of resection as measured by radioactive iodine (RAI) remnant uptake.

Methods

A retrospective review of a prospectively collected thyroid database was queried for patients treated for DTC with TT or CT followed by RAI ablation. CT patients were matched 1:2 by age, sex, and tumor size to TT patients. Surgeon volume, time to completion, and continuity of surgeon care were reviewed.

Results

Over 18 years, 45 patients with DTC had CT and RAI. Mean age was 48 ± 2 years, and 76 % were female, with a tumor size of 2.7 ± 0.3 cm. CT had higher remnant uptake than TT (0.07 vs. 0.04 %; p = 0.04). CT performed by a high-volume surgeon had much lower remnant uptakes (0.06 vs. 0.22 %; p = 0.04). Remnant uptake followed a stepwise decrease with involvement of a high-volume surgeon for part or all of the surgical management (p = 0.11). Multiple regression analysis found CT (p = 0.02) and surgeon volume (p = 0.04) to significantly influence uptake after controlling for other factors.

Conclusions

Single-stage TT provides a better resection based on smaller thyroid remnant uptakes than CT for patients with thyroid cancer. If a staged operation for cancer is necessary, surgeon volume may affect the completeness of resection.

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Acknowledgment

This study was supported by NIH T32 CA009614-23.

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Authors and Affiliations

  1. Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, Madison, WI, USA

    Sarah C. Oltmann MD, David F. Schneider MD, MS, Herbert Chen MD & Rebecca S. Sippel MD

  2. Department of Surgery, University of Wisconsin, Madison, Madison, WI, USA

    Glen Leverson PhD

  3. Wellcare Hospital and Research Institute, Thillai Nagar, Trichy, Tamilnadu, India

    Tamilselvan Sivashanmugam MS, MRCSEd

Authors
  1. Sarah C. Oltmann MD
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  2. David F. Schneider MD, MS
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  3. Glen Leverson PhD
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  4. Tamilselvan Sivashanmugam MS, MRCSEd
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  5. Herbert Chen MD
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  6. Rebecca S. Sippel MD
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Corresponding author

Correspondence to Rebecca S. Sippel MD.

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Oltmann, S.C., Schneider, D.F., Leverson, G. et al. Radioactive Iodine Remnant Uptake After Completion Thyroidectomy: Not Such a Complete Cancer Operation. Ann Surg Oncol 21, 1379–1383 (2014). https://doi.org/10.1245/s10434-013-3450-3

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  • DOI: https://doi.org/10.1245/s10434-013-3450-3

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