Redo Thyroidectomy: Updated Insights

Abstract

The risk of post-operatory hypothyroidism and hypocalcaemia, along with recurrent laryngeal nerve injury, is lower following a less-than-total thyroidectomy; however, a previously unsuspected carcinoma or a disease progression might be detected after initial surgery, hence indicating re-intervention as mandatory (so-called "redo" surgery) with completion. This decision takes into consideration a multidisciplinary approach, but the surgical technique and the actual approach is entirely based on the skills and availability of the surgical team according to the standard protocols regarding a personalised decision. We aimed to introduce a review of the most recently published data, with respect to redo thyroid surgery. For the basis of the discussion, a novel vignette on point was introduced. This was a narrative review. We searched English-language papers according to the key search terms in different combinations such as "redo" and "thyroid", alternatively "thyroidectomy" and "thyroid surgery", across the PubMed database. Inclusion criteria were original articles. The timeframe of publication was between 1 January 2020 and 20 July 2024. Exclusion criteria were non-English papers, reviews, non-human studies, case reports or case series, exclusive data on parathyroid surgery, and cell line experiments. We identified ten studies across the five-year most recent window of PubMed searches that showed a heterogeneous spectrum of complications and applications of different surgeries with respect to redo interventions during thyroid removal (e.g., recurrent laryngeal nerve monitoring during surgery, other types of incision than cervicotomy, the use of parathyroid fluorescence, bleeding risk, etc.). Most studies addressing novel surgical perspectives focused on robotic-assisted re-intervention, and an expansion of this kind of studies is expected. Further studies and multifactorial models of assessment and risk prediction are necessary to decide, assess, and recommend redo interventions and the most adequate surgical techniques.

Keywords: goitre; parathyroid; recurrent laryngeal nerve; redo; surgery; thyroid cancer; thyroid nodule; thyroidectomy; ultrasound.

Figure 1

Flow chart of search according to our methods.

Figure 2

Anterior neck ultrasound on first admission of a 41-year-old female with multinodular goitre and compressive symptoms (the capture highlights the largest nodule on the left thyroid lobe).

Figure 3

Computer tomography one month after first thyroid surgery showing post-operatory fibrosis and oedema (yellow arrows); an anterior neck capture (transversal plane).

Figure 4

Intra-operatory aspects: (upper left) left thyroid remnant tissue (white arrow); (upper right) fibrosis following the first surgery (white arrows); (lower left) identification of the intact right superior parathyroid gland (white arrow); (lower right) left thyroid remnant (post-operatory specimen).

Figure 4

Intra-operatory aspects: (upper left) left thyroid remnant tissue (white arrow); (upper right) fibrosis following the first surgery (white arrows); (lower left) identification of the intact right superior parathyroid gland (white arrow); (lower right) left thyroid remnant (post-operatory specimen).

Figure 5

Skin aspect following redo thyroidectomy after 2 months.

Figure 6

Anterior neck ultrasound after redo thyroidectomy: no thyroid remnant, and persistent post-operatory oedema.