Morbidity  rate of reoperation in thyroid surgery: a different point of view

Anita Kurmann; Uta Herden; Stefan W. Schmid; Daniel Candinas; Christian A. Seiler

doi:10.4414/smw.2012.13643

Original article

Vol. 142 No. 3334 (2012)

Morbidity rate of reoperation in thyroid surgery: a different point of view

Anita Kurmann
Uta Herden
Stefan W. Schmid
Daniel Candinas
Christian A. Seiler

Cite this as:: Swiss Med Wkly. 2012;142:w13643
Published: 12.08.2012

Summary

BACKGROUND: Goitre recurrence is a common problem following subtotal thyroid gland resection for multinodular goitre disease. The aim of the present study was to evaluate morbidity rate in relation to the side of initial and redo-surgery for recurrent disease.

METHODS: A total of 1699 patients underwent consecutive thyroid gland surgery between 1997 and 2010 at our institution. One hundred and eighteen patients (6.9%) underwent redo-surgery for recurrent disease after subtotal resection. One hundred and nine patients with complete follow-up were included in the present study.

RESULTS: Recurrent disease was found in 79 patients (72.5%) in the ipsilateral lobe and in 30 patients (27.5%) in the contralateral lobe. The incidence of permanent recurrent laryngeal nerve palsy was significantly higher in patients undergoing redo-surgery on the ipsilateral lobe compared to patients undergoing initial operation (3.8% vs. 1.1%; p = 0.03), whereas no difference was found in patients with contralateral redo-surgery compared to patients undergoing initial operation (p = 1.0). Independent risk factors for contralateral recurrent disease were age at primary operation <37 years (OR 4.86; 95% CI 1.58–15.01) and time to recurrence <20 years (OR 6.53; 95% CI 2.23–19.01).

CONCLUSION: Morbidity rate for recurrent disease after subtotal resection was significantly higher for ipsilateral redo-surgery compared to initial surgery, whereas redo-surgery can be performed safely on the contralateral lobe. Young age at primary operation and short time to recurrence are independent risk factors for contralateral recurrent disease.

References

Agarwal G, Aggarwal V. Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter? An evidence-based review. World J Surg. 2008;32(7):1313–24.
Seiler CA, Vorburger SA, Burgi U, Candinas D, Schmid SW. Extended resection for thyroid disease has less operative morbidity than limited resection. World J Surg. 2007;31(5):1005–13.
Moalem J, Suh I, Duh QY. Treatment and prevention of recurrence of multinodular goiter: an evidence-based review of the literature. World J Surg. 2008;32(7):1301–12.
Lefevre JH, Tresallet C, Leenhardt L, Jublanc C, Chigot JP, Menegaux F. Reoperative surgery for thyroid disease. Langenbecks Arch Surg. 2007;392(6):685–91.
Muller PE, Jakoby R, Heinert G, Spelsberg F. Surgery for recurrent goitre: its complications and their risk factors. Eur J Surg. 2001;167 (11):816–21.
Gibelin H, Sierra M, Mothes D, Ingrand P, Levillain P, Jones C, et al. Risk factors for recurrent nodular goiter after thyroidectomy for benign disease: case-control study of 244 patients. World J Surg. 2004;28 (11):1079–82.
Erbil Y, Bozbora A, Yanik BT, Ozbey N, Salmaslioglu A, Ozarmagan S. Predictive factors for recurrent non-toxic goitre in an endemic region. J Laryngol Otol. 2007;121(3):231–6.
Menegaux F, Turpin G, Dahman M, Leenhardt L, Chadarevian R, Aurengo A, et al. Secondary thyroidectomy in patients with prior thyroid surgery for benign disease: a study of 203 cases. Surgery. 1999;126(3):479–83.
Wadstrom C, Zedenius J, Guinea A, Reeve T, Delbridge L. Multinodular goitre presenting as a clinical single nodule: how effective is hemithyroidectomy? Aust N Z J Surg. 1999;69(1):34–6.
Rojdmark J, Jarhult J. High long term recurrence rate after subtotal thyroidectomy for nodular goitre. Eur J Surg. 1995;161(10):725–7.
Pappalardo G, Guadalaxara A, Frattaroli FM, Illomei G, Falaschi P. Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports. Eur J Surg. 1998;164(7):501–6.
Harrer P, Brocker M, Zint A, Derwahl M, Barbera L, Zumtobel V. The clonality of nodules in recurrent goiters at second surgery. Langenbecks Arch Surg. 1998;383(6):453–5.
Studer H, Gerber H, Zbaeren J, Peter HJ. Histomorphological and immunohistochemical evidence that human nodular goiters grow by episodic replication of multiple clusters of thyroid follicular cells. J Clin Endocrinol Metab. 1992;75(4):1151–8.
Harrer P, Broecker M, Zint A, Schatz H, Zumtobel V, Derwahl M. Thyroid nodules in recurrent multinodular goiters are predominantly polyclonal. J Endocrinol Invest. 1998;21(6):380–5.

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Morbidity rate of reoperation in thyroid surgery: a different point of view. Swiss Med Wkly [Internet]. 2012 Aug. 12 [cited 2025 Nov. 4];142(3334):w13643. Available from: https://www.smw.ch/index.php/smw/article/view/1556

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DOI:: https://doi.org/10.4414/smw.2012.13643

[1] Agarwal G, Aggarwal V. Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter? An evidence-based review. World J Surg. 2008;32(7):1313–24.

[2] Seiler CA, Vorburger SA, Burgi U, Candinas D, Schmid SW. Extended resection for thyroid disease has less operative morbidity than limited resection. World J Surg. 2007;31(5):1005–13.

[3] Moalem J, Suh I, Duh QY. Treatment and prevention of recurrence of multinodular goiter: an evidence-based review of the literature. World J Surg. 2008;32(7):1301–12.

[4] Lefevre JH, Tresallet C, Leenhardt L, Jublanc C, Chigot JP, Menegaux F. Reoperative surgery for thyroid disease. Langenbecks Arch Surg. 2007;392(6):685–91.

[5] Muller PE, Jakoby R, Heinert G, Spelsberg F. Surgery for recurrent goitre: its complications and their risk factors. Eur J Surg. 2001;167 (11):816–21.

[6] Gibelin H, Sierra M, Mothes D, Ingrand P, Levillain P, Jones C, et al. Risk factors for recurrent nodular goiter after thyroidectomy for benign disease: case-control study of 244 patients. World J Surg. 2004;28 (11):1079–82.

[7] Erbil Y, Bozbora A, Yanik BT, Ozbey N, Salmaslioglu A, Ozarmagan S. Predictive factors for recurrent non-toxic goitre in an endemic region. J Laryngol Otol. 2007;121(3):231–6.

[8] Menegaux F, Turpin G, Dahman M, Leenhardt L, Chadarevian R, Aurengo A, et al. Secondary thyroidectomy in patients with prior thyroid surgery for benign disease: a study of 203 cases. Surgery. 1999;126(3):479–83.

[9] Wadstrom C, Zedenius J, Guinea A, Reeve T, Delbridge L. Multinodular goitre presenting as a clinical single nodule: how effective is hemithyroidectomy? Aust N Z J Surg. 1999;69(1):34–6.

[10] Rojdmark J, Jarhult J. High long term recurrence rate after subtotal thyroidectomy for nodular goitre. Eur J Surg. 1995;161(10):725–7.

[11] Pappalardo G, Guadalaxara A, Frattaroli FM, Illomei G, Falaschi P. Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports. Eur J Surg. 1998;164(7):501–6.

[12] Harrer P, Brocker M, Zint A, Derwahl M, Barbera L, Zumtobel V. The clonality of nodules in recurrent goiters at second surgery. Langenbecks Arch Surg. 1998;383(6):453–5.

[13] Studer H, Gerber H, Zbaeren J, Peter HJ. Histomorphological and immunohistochemical evidence that human nodular goiters grow by episodic replication of multiple clusters of thyroid follicular cells. J Clin Endocrinol Metab. 1992;75(4):1151–8.

[14] Harrer P, Broecker M, Zint A, Schatz H, Zumtobel V, Derwahl M. Thyroid nodules in recurrent multinodular goiters are predominantly polyclonal. J Endocrinol Invest. 1998;21(6):380–5.