Abstract
Backgrounds: Recurrence rate of papillary thyroid carcinoma(PTC) after total thyroidectomy with remnant ablation were reported 10-15%. The primary treatment of recurrent PTC is re-operation because most of recurrences limited in cervical area. However, there were insufficient reports about the clinical course of recurrence and the efficacy of re-operation.
Subjects and methods: Patients with PTC who underwent total thyroidectomy followed by immediate remnant ablation between 1995 and 2003 were studied. Patients showing elevated sTg level at first diagnostic whole body scan (DxWBS), 1 year after remnant ablation comprised basis for this study. We evaluated clinical course of the patients with high sTg value, and the outcome of patients who underwent re-operation for recurrence.
Results: 139 patients had positive sTg value more than 10 ug/dl. In 92 out of 139 (66%) patients, we found recurrence by various imaging modality and 5 patients had lung metastasis. 65 out of 87 patients with neck recurrence underwent re-operation. sTg level after re-operation were as follows: lesser than 1 ug/L in 18 (28%), 1-10 ug/L in 25 (38%) and more than 10 ug/L in 22 (34%). 15 (23%) patients who underwent re-operation had persistent disease in median 52 months of follow up. In 8 of 15 patients, new lung metastasis was found after re-operation whereas 7 patients had persistent disease in neck.
Conclusion: Re-operation for recurrent PTC could decrease sTg level and achieve clinical remission in more than half cases. However, newly recognized lung metastasis was after re-operation in quite a few patients.