Total thyroidectomy for differentiated thyroid cancer

From March 1987 through March 1996, a total thyroidectomy ('IT) has been performed on 258 patients treated in our centre. Of them 39 TT have been performed on cancer patients (29 female, 10 male, mean age 66.5) 19 for papillary tumours, 9 for follicular carcinomas, 9 for mixed papillary follicular carcinomas, 1 for an indifferentiated cancer and 1 for a lymphoma. By total thyroidectomy we mean a total extracapsular intervention. The morbidity rate for this intervention has been: I patient had a temporary recurrent nerve palsy, 2 patients had a transitory hypocalcemia, while only one patient suffered from permanent hypoealcemia. We support TT as the right approach in patients suffering from differentiated thyroid cancer for the following reasons: i) In patients in whom a preoperative diagnosis of differentiated thyroid cancer has been clearly obtained, TT allows a good ontological radicality and an accurate surgical evaluation of neck lymph-nodes metastases. Moreover if distant micrometastases are detected, postoperative radioactive iodine therapy may be successfully used. ii) In patients with an unclear preoperative evaluation due to undetermined cytology or frozen section, for whom the literature reports a frequency of carcinoma ranging from 20 to 60%, TT avoids the need for a re-intervention to remove additional thyroid tissue. iii) In trained hands TT gives a low rate of complications that in addition to the advantages above explained makes this surgical approach to be preferred to less invasive interventions.