Reoperative Thyroid Surgery

Abstract

Abstract Approximately one-third of patients with differentiated thyroid cancer (DTC) have tumor recurrence within the thyroid bed, the central or lateral neck, or the mediastinum. The 2015 American Thyroid Association thyroid cancer guidelines advocate for a new risk-adapted continuum model that provides patients and clinicians with continuously updated risk stratification based on response to therapy during routine follow-up. Using serial thyroglobulin levels and ultrasound imaging, clinicians adapt treatment and follow-up algorithms specific for each patient. Although the standard treatment for most recurrent disease remains reoperative thyroid surgery, low-risk patients with low-volume persistent/recurrent disease can be followed closely with active surveillance. Most of these patients will have stable disease without progression and can avoid any reoperative surgery. Nonsurgical treatment options, including ultrasound-guided percutaneous ethanol ablation, can safely and effectively treat small foci of recurrent or persistent disease, especially in high-risk surgical patients. Reoperative thyroid surgery can be challenging because of anatomic changes after primary surgery, especially in the central neck, and is associated with high complication rates in inexperienced hands. However, with experience and appropriate preparation, rates of permanent hypoparathyroidism and injury to the recurrent laryngeal nerve can be as low as 3% and 1%, respectively. Surgeons contemplating revision thyroid surgery must possess the essential reoperative surgical skills and an intimate knowledge of regional anatomy to achieve such a low morbidity for what can often be a tedious and difficult procedure.