REOPERATION OF THYROID GLAND - A NEW APPROACH TO SUBTOTAL THYROIDECTOMY

Twenty-five cases of reoperation of the thyroid are discussed. Six patients in whom the first operation had been subtotal thyroidectomy for thyrotoxicosis are described in detail. Technical difficulties encountered at reoperation and the danger of injuring the recurrent nerves and parathyroids are stressed. The following modifications of thyroid surgery are suggested with a view to minimizing these hazards: 1. 1. No less than complete hemithyroidectomy should be performed with preservation of recurrent nerve and parathyroids when the disease is restricted to one lobe; when the disease is sited only in the isthmus and/or pyramidal lobe, excision should be performed without touching either thyroid lobe. 2. 2. Classical subtotal thyroidectomy leaving remnants of thyroid tissue on both sides should be replaced by total excision of one lobe and the isthmus with preservation of the recurrent nerve and parathyroids plus intracapsular two thirds evacuation of thyroid tissue from the other lobe. If the necessity of reoperation should arise, the function of the recurrent nerve and parathyroids will be safeguarded at least on one side. © 1968.