Mohamed AF Hegazy, Waleed Elnahas, Khaled M Abdel Wahab and Adel T Denewar
Background: The optimal extent of surgery for differentiated thyroid cancers (DTC) is controversial. The aim of this study is to assess the frequency and potential predictive factors of residual malignancy in the lobe contralateral to the main tumor. The secondary aim was to assess the safety of completion thyroidectomy. Methods: All total thyroidectomies performed at our institution between 2004 and 2010 were reviewed identifying 185 patients (70 cases underwent completion thyroidectomy and 115 cases underwent initial total thyroidectomy). The predictive value of sex, age, tumor size, histology, multifocality, perithyroid extension, and lymph node involvement was analyzed. Results: we report a high rate of multifocality (51%) in the whole cohort of cases and of contralateral disease (35%). There were no differences in multifocality rates for sex, age, pathology types and tumor size. PTC cases <1cm have a similar contralateral disease to cases >1 cm (45% versus 59% respectively). Moreover, there was no significant correlation between ipsilateral multifocality and contralateral disease in our cases. In our series, the complication rates for both completion thyroidectomy and total thyroidectomy were comparable. Conclusion: Absence of significant predictive factors that could suggest a residual disease justifies total thyroidectomy as a primary treatment for cases of DTC. Hemithyroidectomy for management of cases of DTC smaller than 1 cm with absence of multifocal disease in the ipsilateral lobe should be questioned.
