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Completion Thyroidectomy for Well-differentiated Thyroid Cancer

Marcin Barczyński

Completion thyroidectomy should be offered to those patients for whom a near-total or total thyroidectomy would have been recommended had the diagnosis been available before the initial surgery. This includes all patients with thyroid cancer except those with small (<1 cm), unifocal, intrathyroidal, node-negative, low-risk tumors. Therapeutic central neck lymph node dissection should be included if the lymph nodes are clinically involved. Ablation of the remaining lobe with radioactive iodine has been used as an alternative to completion thyroidectomy. It is unknown whether this approach results in similar long-term outcomes. Consequently, routine radioactive iodine ablation in lieu of completion thyroidectomy is not recommended.

Although reoperative thyroid surgery carries a higher risk of operative complications than initial thyroid surgery, experience has demonstrated that it can be performed safely by several different techniques. Nevertheless, thyroid surgeon in their practice should be aware of how to minimize the need for reoperative thyroid surgery and strictly adhere to detailed preoperative work-up and individual risk assessment before initial operation. Nothing less than a unilateral lobectomy with isthmusectomy should be performed as well as the surgeon must make every effort to preserve all encountered parathyroid glands and protect the recurrent laryngeal nerve at initial operation. Several adjuncts to thyroid surgery like intraoperative nerve monitoring or intraoperative iPTH assay may be of help in improving outcomes of individual performance. Such a strategy plays an ever increasing role in improving quality of thyroid surgery worldwide.