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Thyroidectomy in patients with thyroid cancer is rarely complete
The background of the study. Many patients with thyroid cancer are treated by total thyroidectomy, but then are found postoperatively to have tissue in the thyroid bed, indicating that the thyroidectomy was incomplete. In this study, the completeness of total thyroidectomy in patients with thyroid cancer was systematically evaluated.
How the study was done. The study subjects were 720 patients with thyroid cancer treated by total thyroidectomy at a single hospital. The tumor was a papillary cancer in 628 patients (87 percent) and a follicular cancer in 92 (13 percent).
Two to 4 months after surgery, 24-hour thyroid iodine-131 (I-131) uptake was measured. The patients then were treated with 50 to 150 mCi (1850 to 5550 MBq) of I-131 to destroy any remaining thyroid tissue, followed 2 to 5 days later by whole-body scans.
All patients in whom the scan performed after I-131 therapy revealed any thyroid tissue had a diagnostic whole-body I-131 scan 6 to 10 months later. Successful I-131 therapy was defined as a 24-hour I-131 uptake of <1 percent and no visible thyroid uptake on the follow-up scan. Patients who had I-131 uptake in the thyroid bed at this time were treated with I-131 again.
The results of the study. The scan performed after I-131 therapy revealed no thyroid tissue in 50 of the 720 patients (7 percent). Their mean 24-hour thyroid I-131 uptake was 0.3 percent. The best predictor of the absence of visible I-131 uptake on the post-therapy scan was a 24-hour thyroid I-131 uptake of 
1 percent.
The scans performed after I-131 therapy revealed foci of uptake in the thyroid region in 670 patients (93 percent). Their average 24-hour thyroid I-131 uptake was 2.9 percent. As determined by the follow-up scan done 6 to 10 months later, the I-131 therapy successfully destroyed the thyroid remnant(s) in 610 of these 670 patients (91 percent).
The conclusions of the study. Most patients with papillary or follicular cancer of the thyroid who undergo total thyroidectomy have a small amount of residual thyroid tissue.
The original article. Salvatori M, Raffaelli M, Castaldi P, Treglia G, Rufini V, Perotti G, Lombardi CP, Rubello D, Ardito G, Bellantone R. Evaluation of the surgical completeness after total thyroidectomy for differentiated thyroid carcinoma. Eur J Surg Oncol 2007;33:648-54.
 Next Article: The outcome of papillary thyroid cancer is similar in patients with hyperthyroidism caused by Graves’ disease and patients with normal thyroid function |
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| Thyroid Digest Index | | | November 2007 Thyroid Digest |
