Recurrent Papillary Thyroid Cancers: An Evolving Paradigm

Abstract

Objective Improved diagnostic techniques are changing the paradigm of recurrent thyroid cancer detection. High resolution ultrasound techniques, recombinant thyroglobulin assays and fused PET/CT imaging are detecting small recurrent thyroid cancers and prompting earlier surgical intervention. Our study seeks to identify the surgical outcomes in one of the largest series of recurrent papillary thyroid cancers. Methods A retrospective chart review identified 48 patients who underwent central and/or lateral neck dissections for recurrent papillary thyroid disease at our institution between 1999 and 2007. All of the patients had previously undergone primary thyroid surgery. Results There were 36 females, 12 males and the mean age of first recurrence was 49.8 years. 11 recurrences were identified by screening thyroglobulin, 10 had positive ultrasound findings, and 11 presented with a cervical mass. 14 patients underwent PET/CT scans and 28 had fine needle aspirations as part of their workup. No patients (0%) acquired permanent vocal cord paralysis and two (4.2%) developed hypoparathyroidism as a result of their initial reoperation for recurrent disease. 10 patients had a second recurrence. Conclusions Recurrent papillary thyroid cancer is a challenging dilemma for the thyroid surgeon. Improved surveillance techniques are allowing the earlier diagnosis of recurrence. While reoperative thyroid surgery carries many risks, our series demonstrates that it can be done with minimal complications. The long-term implications of early intervention in this setting are still largely unknown and will warrant future research.