Reoperative thyroid surgery: approach and hazards

This study included 34 patients [25 females and 9 males with an age range from 25 to 72 years and a mean age of 38 years] subjected to reoperative thyroid surgery. 131I thyroid scan and whole body scan were performed. Surgical techniques were attempted, where different surgical procedures were performed. 131I ablation of thyroid remnants was carried out in patients with thyroid cancer and for those with relapsed toxic goiter. Operative complications were studied. Follow-up of patients with complications and those with thyroid cancer was done. The results showed that morphologically unilateral thyroid with isthmic involvement were found in 50% of patients. Diffuse thyroid enlargement accounted for about one-third of patients. Histologically, recurrent nodular goiter was found in 56% of patients, followed by recurrent toxic goiter [21%], thyroid carcinoma [21%] and chronic lymphocytic thyroiditis [one patient]. Surgically, the majority of patients were explored with standard Kocher incision [85%] and the remaining with adding lateral cervical approach. Extracapsular thyroidectomy was the commonest technique. Hemithyroidectomy followed by subtotal thyroidectomy were the commonest procedure, followed by near-total and total thyroidectomy. Recurrent laryngeal nerve was identified in 35% of patients, mainly in its lower cervical course, followed by middle third in relation to inferior thyroid artery. Temporary recurrent laryngeal nerve palsy occurred in 12% and permanent unilateral nerve palsy in 6% of patients. Parathyroid glands were identified in 24% of cases. Temporary and permanent hypocalcemia occurred in 15% and 12%, respectively. Complete ablation with 131I was achieved in four patients of thyroid carcinoma and partial ablation with 131I in the remaining three patients