Yusuf AYDİN, Leyla IRAK, Hüseyin DEMİRCİ, Türkan METE, Halise YAVUZ ÇINAR, Serdar GÜLER

Malignancy and Complication Rate in Reoperation of Recurrent Goiter

Amaç: Bu çalışmanın amacı, benign nedenlerle subtotal tiroidektomi veya lobektomi yapılmış nüks guatrı olan hastaların ince iğne aspirasyon biyopsi bulgularını değerlendirmek ve yeniden opere edilenlerdeki malignite ve komplikasyon sıklığını belirlemektir. Gereç ve Yöntem: 2008 ve 2009 yılları arasında, nüks guatrı olan 114 hasta çalışmaya dahil edildi. 158 nodülün sitolojik bulguları ve yeniden opere edilen 18 hastaya ait histolojik bulgular incelendi. İlk cerrahiye bağlı gelişen komplikasyonlar ve nüks guatr nedeni ile yapılan operasyona bağlı gelişen komplikasyonlar belirlendi. Bulgular: Çalışmaya dahil edilen hastaların 106'sı ötiroid multinodüler guatr, 8' i toksik multinodüler guatr nedeni ile opere olmuştu. İlk operasyondan bu yana geçen süre ortalama 16,5±7,5 yıldı. İnce iğne aspirasyon biyopsisi sonucu malignite şüphesi gelen 6, malignite gelen 3, hurthle hücreli lezyon gelen 5, selüler mikrofolliküler lezyon gelen 7, yetersiz sitoloji sonucu olan 2 ve toksik multinodüler guatrı olan 1 hasta; toplam 24 hastaya (%21) yeniden operasyon önerildi. Yeniden operasyonu kabul eden 18 hastanın 2'sinde papiller mikrokarsinom ve 2'sinde papiller tiroid karsinomu saptandı. Yeniden opere edilen 18 hastanın 7'sinde cerrahiye bağlı komplikasyonlar gelişti: 3 hastada vokal kord paralizisi ve 4 hastada hipoparatiroidi. Sonuç: Çalışmamızda, nüks guatrı olan hastalarda yüksek oranda yeniden operasyon gereksinimi olduğunu ve yeniden yapılan tiroid cerrahisinin önemli miktarda komplikasyon ile ilişkili olduğunu bulduk. Yeniden operasyona bağlı gelişebilecek potansiyel riskleri önlemek için, benign nedenlerle yapılan primer cerrahide subtotal tiroidektomi veya lobektomi yerine total tiroidektominin seçilmesini önermekteyiz.

Nüks Guatr Nedeni ile Yapılan Operasyonlarda Malignansi ve Komplikasyon Sıklığı

Objective: The aim of this study was to evaluate the fine needle aspiration biopsy findings of recurrent goiter patients who were operated subtotally or lobectomised for benign causes, and to determine the malignancy and complication rates for those who were reoperated. Methods: Between 2008 and 2009, 114 patients diagnosed with recurrent goiter were involved in this study. The cytological findings of 158 nodules and histological findings of 18 patients with reoperation were examined. The complications of primary surgery and reoperation of recurrent goiter were determined. Results: The operation indications were euthyroid multinodular goiter in 106 of the patients and toxic multinodular goiter in 8 of them. The average time elapsed from the time of the first operation was 16.5±7.5 years. The patients with a fine needle aspiration biopsy resulted in 6 with suspicion of malignancy, 3 with malignancy, 5 with hurtle cell cytology, 7 with cellular microfollicular lesion, 1 patient with toxic multinodular goiter and 2 with inadequate cellular cytology; a total of 24 patients (21%) were asked for reoperation. Among the 18 patients who accepted reoperation, pathology results discovered 2 papillary microcarcinomas and 2 papillary thyroid carcinomas. A total of 7 of the 18 patients with reoperation had surgical complications: 3 had vocal cord paralysis and 4 had hypoparathyroidism. Conclusion: In our study, we found that a high rate of recurrent goiter patients required reoperation and there was a considerable amount of complication rate of reoperative thyroid surgery. To eliminate the potential risk of reoperation, we recommend a total thyroidectomy instead of subtotal thyroidectomy or lobectomy as the surgery of choice for the primary surgery with benign indications.

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