Total Thyroidectomy and Lymph Node Dissection in Patients With Papillary Thyroid Carcinoma

Abstract

I n a recent issue, Kim et al 1 associated total thyroidectomy and lymph node dissection with a higher survival rate in patients with thyroid carcinoma who were older than 60 years and classified as high risk according to age, metastases, extent, and size. However, these procedures might also carry a higher risk of complications. In favor of total thyroidectomy and lymph node dissection, we report the results of 185 patients seen at our institution who underwent total thyroidectomy for papillary carcinoma, with lymph node dissection performed in 95 of them. Definitive hypoparathyroidism was observed in only 4 patients (2.1%), and permanent recurrent laryngeal nerve palsy with vocal cord paralysis occurred in only 2 (1.0%). The complication rate did not differ between patients who did or did not undergo lymph node dissection (3.1% vs 3.3%). Uptake in the thyroid bed as a parameter of remnant thyroid tissue was less than 5% (mean, 2.4%) in 94.0% of the patients, with no significant difference between patients with or without complications. Age older than 60 years also was not associated with a higher risk of complications (4.0% vs 3.0% in subjects 60 years; P=.71). We observed that total thyroidectomy is a procedure with a low rate of definitive complications and that lymph node dissection and age older than 60 years do not indicate a higher risk. These findings, together with the benefits reported by Kim et al, reinforce the use of total thyroidectomy in combination with lymph node dissection as the procedure of choice in high-risk patients.