THYROID AND PARATHYROID DISEASES: DIAGNOSIS, TREATMENT AND SURGERY WITH CURRENT APPROACHES

thyroid_and_parathyroid_diseasesnevinsakoglukapak1-0-25

MANAGEMENT OF RECURRENT THYROID AND PARATHYROID DISEASES

Ali Kemal Taşkın

Bursa Yüksek İhtisas Training and Research Hospital, Department of General Surgery, Bursa, Türkiye

Taşkın AK. Management of Recurrent Thyroid and Parathyroid Diseases. Kesici U, ed. Thyroid and Parathyroid Diseases: Diagnosis, Treatment and Surgery with Current Approaches. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.149-161.

ABSTRACT

Recurrent thyroid disease is the pathological recurrence of disease after primary thyroid surgery. Indications for reoperation in recurrent thyroid disease are divided into three groups: malignancy, multinodular goiter, and thyrotoxicosis. Postoperative recurrence occurs after 10 years or more. Most patients do not require reoperation. Resection of an enlarged recurrent thyroid nodule is difficult due to the disruption of anatomical planes and fibrotic tissues that form. Possible risks should be revealed and this should be discussed clearly with the patient. Especially recurrent laryngeal nerve (RLN) damage and vocal cord paralysis may occur in recurrent nodular goiter surgery. Reoperation surgery is usually performed through a lateral incision to reach recurrent thyroid nodules. For visual identification of the RLN, nerve monitoring is the gold standard at reoperation. Recurrent hyperparathyroidism is defined as the reappearance of hypercalcemia (calcium >10.5 mg/dL) at least six months after postoperative normocalcemia. Recurrence rates in the literature range between 1% and 9.8%. Causes of recurrent hyperparathyroidism include adenoma (68%), parathyroid hyperplasia (28%), parathyroid carcinoma (3%), and other causes such as parathyromatosis or autograft relapse (1%). Recurrent parathyroid dis- ease may recur in the parathyroid bed, regional lymph nodes, or ectopic locations such as retroesopha- geal, mediastinal, intrathyroidal, intrathymic, carotid sheath, axilla, or pericardium. Before surgery for recurrent parathyroid disease, the patient’s medical and family history should be thoroughly reviewed. Recurrence typically occurs at the primary site, making preoperative imaging (USG, MRI, or techne- tium Tc99m sestamibi scintigraphy) essential. For suspicious cases, neck and chest CT scans should be performed. Fine-needle aspiration under ultrasound guidance may be considered for carefully selected suspicious lesions. Lateral approach is more suitable to reduce the risk of complications. Intraoperative parathyroid hormone (PTH) is checked after excisional treatments.

Keywords: Postoperative complications; Complications; Recurrent laryngeal nerve

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