Completion Thyroidectomy

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Residual tumor is common in the contralateral thyroid lobe but cannot be predicted on the basis of the tumor size in the ipsilateral lobe or the presence of regional lymph node metastases [45] but is more likely if there are multiple tumors in the ipsilateral thyroid lobe and if the serum thyroglobulin level is very high [46]. Completion thyroidectomy should be considered for tumors that have the potential for recurrence because large thyroid remnants are difficult to ablate with 131I [47] and almost always leave the serum thyroglobulin detectable [48]. Completion thyroidectomy has a low complication rate and is appropriate to perform routinely for tumors 1cm or larger because about half the patients have residual cancer in the contralateral thyroid lobe [49-53]. This is more common when the tumor is familial, or when it is associated with head and neck irradiation or other familial syndromes (see Chapter 1).

When there has been a local or distant tumor recurrence after lobectomy, residual cancer is found in over 60% of the excised contralateral lobes. A study of irradiated children from Chernobyl with thyroid cancer that had been treated by lobectomy found that 61% had unrecognized lung or lymph node metastases that could only be identified after completion thyroidectomy had been performed [37]. In another study, patients who underwent completion thyroidec-tomy within 6 months of their primary operation developed significantly fewer lymph node and hematogenous recurrences and survived significantly longer than those in whom the second operation was delayed for longer than 6 months [53].

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