Incidental occult carcinomas in total thyroidectomy for benign diseases of the thyroid

Total thyroidectomy is increasingly recognised as the preferred surgical option for benign diseases of the thyroid. One factor contributing towards this change in policy is reports of incidental carcinomas in the resected specimens.

This was a prospective study of patients, who underwent total thyroidectomy for benign diseases of the thyroid at the University Surgical Unit, Colombo North Teaching Hospital from January 2003 to December 2005.

There were 68 patients (67 females) aged 28 to 67 years (mean 44.2 (SD=11.1). In 6 (8.8%) patients, histological examination of the post-operative specimen showed incidental carcinomas: 2 papillary, 2 medullary and 2 follicular carcinomas. There was no significant difference in age, clinical presentation and functional thyroid status of patients with incidental carcinomas and those with histologically confirmed benign diseases.

Occurrence of incidental thyroid cancers was 8.8% in this series, and they were difficult to predict pre-operatively. The policy of performing total thyroidectomy for benign disease of the thyroid obviates the need for further surgery if an incidental carcinoma is found.