Your institution is subscribed to Read Institutional Edition. Log in or Sign Up to read full text articles.

JOURNAL ARTICLE

Surgical strategy for thyroid bed recurrence in patients with well-differentiated thyroid carcinoma

Carsten E Palme, Jeremy L Freeman
Journal of Otolaryngology 2005, 34 (1): 7-12
15966469

BACKGROUND: Well-differentiated thyroid carcinoma (WTC) has a low but definite rate of recurrence. The majority of these occur locoregionally and present a significant diagnostic and management challenge. It is the aim of this article to convey the complexities associated with revision surgery involving the thyroid bed and to present sound surgical strategies to deal with this problem in a manner that minimizes morbidity, adheres to oncologic principles, and achieves appropriate cure rates.

METHOD: Between 1992 and 2002, 14 patients with revision surgery involving the thyroid bed were identified and managed according to an algorithm taking into account clinical, biochemical, and radiologic indices. All underwent revision surgery, and we applied our technique of wide field exposure by horizontally sectioning all of the ipsi- or bilateral strap muscles. We use blunt dissection to identify the recurrent laryngeal nerves and parathyroid glands.

RESULTS: There were six males and eight females, with a median age of 38 years (range 23-62 years). The median time between procedures was 25 months (range 6-120 months). The diagnosis was established by clinical examination, thyroglobulin determination, and/or imaging. All were treated with surgery and postoperative iodine 131 (I131). The median follow-up was 6 months (range 2-48 months). Complications included two cases of temporary recurrent laryngeal nerve palsy, two patients with permanent and two patients with temporary hypocalcemia, two cases of temporary chyle leaks, and one recurrence. One patient underwent a negative exploration.

CONCLUSION: The management of infield recurrence of WTC presents both a diagnostic and a therapeutic challenge owing to the disparity in presentation, the complexity of the anatomy, and indistinct tissue planes. The optimal treatment of these patients is surgical resection and postoperative I131. This can be accomplished safely and with little morbidity. The key to this type of surgery is a sound and systematic approach.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
15966469
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"

We want to hear from doctors like you!

Take a second to answer a survey question.