title: Safety of Completion Thyroidectomy for Initially Misdiagnosed Thyroid Carcinoma.
abstract: BACKGROUND
  Completion thyroidectomy is defined as the surgical removal of the remnant thyroid tissue following procedures of less than total or near-total thyroidectomy. Whether thyroid reoperations are associated with an increased complication risk is controversial.
  
  
  OBJECTIVE
  A retrospective analysis was done of patients undergoing completion thyroidectomy for cancer of the thyroid who had undergone surgery elsewhere for solitary thyroid nodule. The incidence of surgical complications in these patients after reoperation was investigated in this study.
  
  
  METHODS
  The study included a total of 53 patients who had undergone thyroid lobectomy for a solitary nodule as initial surgery elsewhere and were referred to our institute for completion thyroidectomy when the histopathology revealed malignancy.
  
  
  RESULTS
  There were 53 patients, 43 females and 10 males. Their mean age was 34.7±12.12 years (range 19-65 years). After initial surgery, the histopathology revealed papillary carcinoma in 46 patients (86.8%), follicular carcinoma in 7 (13.2%). Fourteen out of 53 patients had recurrent laryngeal nerve palsy after initial surgery (26.4%). None of the patients had clinical hypocalcemia after the first surgery. One or more parathyroid glands were identified and preserved in 52 patients (98.1%) in the process of completion thyroidectomy. No patient had additional recurrent nerve injury at the second surgery. The mean serum calcium value preoperatively was 8.96±0.39 mg/dL, and six months after surgery serum calcium was 8.74±0.56 mg/dL. Mean follow-up was 18 months. Transient hypoparathyroidism occurred in 24.5% patients. Five patients were lost to follow-up. Permanent and symptomatic hyperparathyroidism occurred in eight patients (16.67%).
  
  
  CONCLUSIONS
  Completion thyroidectomy is a safe and appropriate option in the management of well-differentiated thyroid cancer. It removes disease on the ipsilateral and contralateral side of the thyroid and carries a low risk of recurrent laryngeal nerve damage, but a higher risk of permanent hypoparathyroidism.
authors.affiliation: Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India.
authors.forename: Gangiti
authors.initials: G
authors.lastname: Kranthikumar
authors.affiliation: Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India.
authors.forename: Nusrath
authors.initials: N
authors.lastname: Syed
authors.affiliation: Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India.
authors.forename: Hemantkumar
authors.initials: H
authors.lastname: Nemade
authors.affiliation: Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India.
authors.forename: Satish
authors.initials: S
authors.lastname: Pawar
authors.affiliation: Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India.
authors.forename: L M
authors.initials: LM
authors.lastname: Chandra Sekhara Rao
authors.affiliation: Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India.
authors.forename: T
authors.initials: T
authors.lastname: Subramanyeshwar Rao