EVALUATING THE ROLE OF COMPLETION THYROIDECTOMY IN PATIENTS WITH THYROID CANCERS

Abstract

Background: Completion thyroidectomy is often performed in differentiated thyroid carcinoma patients who have undergone lobectomy, but its use is contentious because it is felt to overtreat and has surgical morbidity. Clinical decision making should consider the risk of contralateral malignancy and complications of the procedure to reach the right decision.

Aim: To evaluate the incidence of contralateral malignancy following completion thyroidectomy and to assess associated clinicopathological outcomes and postoperative complications.

Methods: This is a single-group retrospective cohort study carried out for six months from 01 December 2024 till 31 May 2025 involving 257 cases of patients that had completion thyroidectomy in the Section of Head and Neck Surgical Oncology, Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC) in the period of 10 years.  The electronic medical records were accessed and provided demographic, clinical, and histopathological information. Quantitative variables were given in terms of the mean with standard deviation and categorical variables in terms of frequencies and percentage. The Chi-square tests were used to determine the associations between clinicopathological factors and outcomes, aned p ≤ 0.05 was taken as statistically significant.

Results: The mean age was 41.05 ± 11.86 years, and 75.5% of patients were female. Contralateral papillary thyroid carcinoma was identified in 35.0% of cases, while 53.7% showed no residual disease. Tumor size ≥3 cm (64.4% vs. 39.9%, p = 0.002) and age >40 years (60.0% vs. 44.9%, p = 0.037) were significantly associated with residual malignancy. Compression symptoms (p = 0.011), retrosternal extension (p = 0.043), and preoperative hoarseness (p = 0.008) were also significant predictors. Postoperative hypocalcemia occurred in 20.2% of patients, particularly in those with larger tumors and extensive prior surgery (p < 0.001), while postoperative vocal cord palsy was observed in 0.8%.

Conclusion: A significant incidence of contralateral malignancy was found with tolerable complication rates by completion thyroidectomy. Further predictors of bilateral disease included larger tumor size, older age, and compressive characteristics, which suggest selective surgical completion to use in high-risk patients.