title: Neural monitored revision thyroid cancer surgery: surgical safety and thyroglobulin response.
abstract: OBJECTIVE
  To evaluate the postoperative complications and to evaluate and stratify thyroglobulin (Tg) response associated with revision surgery for thyroid malignancy.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Academic, tertiary care center.
  
  
  METHODS
  All patients with regionally recurrent thyroid carcinoma and who underwent revision thyroid surgery by the senior author (GWR) during a 5-year period were identified. All patients had pre- and postoperative laryngeal examination and underwent surgery with standardized neural monitoring. Postoperative complications and thyroglobulin (Tg) response were recorded.
  
  
  RESULTS
  One hundred seventeen cases meeting the criteria for revision surgery for recurrent thyroid cancer were identified. Among this group, 30% presented for their third or higher revision procedure. Preoperative permanent vocal cord palsy was present in 14% (n = 16), and 19% (n = 22) had preoperative permanent hypocalcaemia. There were no new cases of either temporary or permanent vocal cord palsy in our study group. Approximately 5% developed temporary and 3% permanent hypocalcaemia requiring medical treatment. The mean basal Tg following revision surgery was 5.6 ng/ml (range, 0.2-32.7), which represented a mean postoperative significant decline in Tg of approximately 90%. In nearly 40%, basal Tg was undetectable postoperatively. Tg response was stratified based on the number of revision surgeries, Tg decline was observed in 90% of all cases, 92% after first revision surgery, 85% after second, 34% after third, and 70% after fifth revision surgeries.
  
  
  CONCLUSIONS
  Revision thyroid cancer surgery can be performed with low rates of complications and significant impact on Tg levels even after multiple revision surgeries.
authors.affiliation: Division of Thyroid and Parathyroid Surgery, Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02114, USA.
authors.forename: Eimear
authors.initials: E
authors.lastname: Phelan
authors.forename: Dipti
authors.initials: D
authors.lastname: Kamani
authors.forename: Jennifer
authors.initials: J
authors.lastname: Shin
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Randolph
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000473:pathology / Q000601:surgery*; D012086:Reoperation / Q000009:adverse effects*; D013954:Thyroglobulin / Q000097:blood*; D013964:Thyroid Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects*; D014826:Vocal Cord Paralysis / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D055815:Young Adult
chemical_list: D013954:Thyroglobulin
keywords: IONM; complications of revision surgery; hypocalcemia; hypoparathyroidism; neural monitoring; papillary thyroid carcinoma; recurrent laryngeal nerve injury; revision thyroid surgery; thyroglobulin Tg response; thyroid cancer recurrence