Total thyroidectomy for differentiated thyroid carcinoma: primary and secondary operations

Aims: There is considerable controversy concerning the most appropriate surgical treatment of patients with differentiated thyroid carcinoma (DTC). Although some authors have advocated subtotal thyroidectomy because of the decreased surgical morbidity and the lack of improved survival with a more extensive procedure, total thyroidectomy has been defended by others as a treatment of choice with lower morbidity. Methods: We reviewed 106 consecutive patients who had been treated with total thyroidectomy for DTC to determine the complication rate. Forty-seven patients had primary operations and 59 had reoperations with completion of total thyroidectomy. Results: Residual tumour in the remnant thyroid tissue was found in 53.8% of patients who underwent prophylactic completion thyroidectomy. Permanent hypoparathyroidism was present in one (0.9%) patient and accidental transient unilateral recurrent laryngeal nerve injury occurred in 2.8% of the entire series. No patient had permanent bilateral recurrent nerve palsy. Furthermore, the risk of complication was not significantly different when comparing primary total thyroidectomy or completion surgery. Conclusions: We recommend total thyroidectomy as a safe treatment for DTC with a low rate of morbidity.