Completion thyroidectomy of well-differentiated thyroid cancer — a prospective, miserandomised study

Abstract

Introduction: Postoperatively diagnosed papillary or follicular thyroid cancer in subtotally thyroidectomised patients requires a completion
thyroidectomy. Re-operation with a gamma probe can be particularly useful in these patients.
The aim of this study was to evaluate the benefits of using an intraoperative hand-held gamma detector during completion thyroidectomy
in patients with well-differentiated thyroid cancer (WTC).
Material and methods: 75 patients with WTC qualified for total re-thyroidectomy. In 43 patients, Group I (Nav), a hand-held gamma
probe (Navigator GPS) was used intraoperatively. 32 patients were re-operated without the gamma probe (Group II). In Group I, thyroid
remnants were removed based on counted gamma signals. To estimate the radicality of reoperation in both groups, thyroglobulin (Tg)
levels were determined and total body scanning (TBS) — I131 uptake — was performed.
Results: Total thyroidectomy with central lymphadenectomy was performed in 75 cases. The average level of Tg and iodine uptake after
radicalisation was lower in Group I (Nav) than in Group II (3.32 ± 2.09 v. 4.58 ± 2.5 ng/mL, respectively, for Tg [p = 0.021] and 6.29 ±
3.38 v. 7.31 ± 2.29 ng/mL, respectively, for iodine uptake [p = 0.187]). Additionally, the frequency of postoperative complications was
comparable, the difference in both groups was not significant, despite the use of the gamma probe (p = 0.109).
Conclusions: The intraoperative use of a hand-held gamma detector can help to improve the radicality of a completion thyroidectomy
procedure after an incomplete primary thyroid resection, but the results of this procedure in the hands of an experienced surgeon are
comparable whether or not the gamma detector is used. (Endokrynol Pol 2013; 64 (5): 335–339)