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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2005 August;18(4):157-62
Incidental carcinoma of the thyroid: our experience
Valduga P., Zani B., Famà R., Dvornik G., Ciola M., Rossi M., Eccher C.
Aim. The incidental carcinoma of the thyroid is an occasional neoplasm in patients thyroidectomized owing to benign pathology. They often are neoplasms whose size is smaller than 1 cm and are defined microcarcinomas by the World Health Organization (WHO). In literature there has been a particular discussion about the most advisable surgical treatment.
Methods. From 1997 to 2002, we observed 17 incidental carcinomas of the thyroid, with a frequency of 2.9% out of all thyroid operations and of 3.2% out of the operations due to benign pathology. The preoperative diagnosis was: multinodule goitre in 11 patients, thyroid nodules in 5 patients and Basedow disease in 1 patient. Eleven patients underwent a total thyroidectomy, 6 a lobe-isthmectomy: 3 of these latter had to undergo a total thyroidectomy owing to an incidental carcinoma >1 cm (1 case) or a multifocal microcarcinoma (2 cases). In one case we discovered a neoplasm in the removed thyroid residue.
Results. In total we observed 4 papillary carcinomas >1 cm (2 monofocal, 2 multifocal), 1 Hurtle cell carcinoma of 1.5 cm and 12 microcarcinomas (10 monofocal, 2 multifocal). Only one case of local relapse of a microcarcinoma of 1 cm occurred 2 years and 9 months after the operation.
Conclusion. While in incidental carcinoma of the thyroid >1 cm a total thyroidectomy is performed, the observation of small monofocal carcinomas following conservative treatment (lobectomy or lobe-isthmectomy) does not justify a radical surgery, which is correct in multifocal carcinomas. Total thyroidectomy has been performed in most of our cases due to the extension of the pathology. Therefore, only a few patients could undergo conservative treatment, which in selected cases, is successful. However, a careful postoperative follow-up is needed after a conservative treatment, since there is a potential risk of a long term, local, lymph-node recurrence.