Occult Thyroid Carcinoma in Our Experience - Should We Reconsider Total Thyroidectomy for Benign Thyroid Pathology

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Occult Thyroid Carcinoma in Our Experience - Should We Reconsider Total Thyroidectomy for Benign Thyroid Pathology

L. Alecu, M. Bărbulescu, B. Ursuţ, O. Enciu, I. Slavu, V. Braga
Original article, no. 2, 2014
Background: The reported incidence rate of occult thyroidcarcinoma in patients operated for benign thyroid pathologyhas been much higher than expected in the last years,especially for multinodular goitre, which raises the questionabout which should the proper surgical management forthese cases be.Aim: To assess the incidence rate of OTC in a single mediumvolume surgical center and to establish the correct indicationfor initial surgical management, as well as to identify thebenign thyroid pathology most frequently associated withOTC. We also reviewed the relevant scientific literature on thistopic.Material and Method: We conducted a retrospective study inthe General Surgery Clinic of “Prof. dr. Agrippa Ionescu”Clinical Emergency Hospital, Bucharest, on a series of 145patients who underwent surgical interventions for preoperativelydiagnosed benign thyroid pathology over a ten yearperiod, between 1st January 2002 â€" 31st December 2012. Allcases of known thyroid cancer were excluded.Results: Incidence rate of occult thyroid carcinoma in our serieswas 6.9 % (10 out of 145 patients), 80 % of them beingdiagnosed with multinodular goitre and two cases (20 %) withHashimoto’s lymphocytic thyroiditis. 6.8 % of all patients withmultinodular goitre were found to present occult carcinoma,but this association was without statistical significance(p 0.05). Incidence rate of occult cancer among patients withHashimoto thyroiditis was proved to be as high as 28.6%,statistically significant (p=0.020). The mean size of postoperativelydiagnosed occult microcarcinoma was 7 mm, rangingbetween 3 mm and 14 mm, 90% of them being smaller than 1cm. Histologically, papillary microcarcinoma was found in allcases. The mean age of the patients diagnosed with occultmicrocarcinoma was 47.8 years with majority of the femalegender. The most frequent operation performed was totalthyroidectomy (70.8%). Overall morbidity in our series was6.9% with a 0.7 % mortality rate (1 case).Conclusions: In our opinion, primary total thyroidectomyshould be performed as the procedure of choice for the mostpart of preoperatively diagnosed benign thyroid pathology andparticularly for multinodular goitre and Hashimoto thyroiditis,in order to radically resect all possible foci of aggressive thyroidmicrocarcinomas.Abbreviations and Acronyms: OTC (Occult ThyroidCarcinoma), PTMC (Papillary Thyroid Microcarcinoma); TT(Total Thyroidectomy), MNG (Multinodular Goitre), GD(Graves’ disease), TNG (Toxic Nodular Goitre), FNAB(fine-needle aspiration biopsy).