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Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Head and Neck Surgery

Background:

  • Central neck dissection (CND) in potentially malignant thyroid disease is controversial regarding morbidity.
  • Rates of hypoparathyroidism and recurrent laryngeal nerve (RLN) palsy after first-step CND (FS-CND) are analyzed.

Purpose of the Study:

  • To analyze the morbidity associated with prophylactic central neck dissection (level 6) in potentially malignant thyroid disease.
  • To compare the rates of hypoparathyroidism and RLN palsy between patients undergoing FS-CND and those undergoing thyroidectomy alone.

Main Methods:

  • Prospective documentation of hypoparathyroidism and RLN palsy rates in 112 patients undergoing bilateral (n=68) or unilateral (n=44) FS-CND before total thyroidectomy.
  • Comparison with 237 control patients who underwent total thyroidectomy only.

Main Results:

  • Transient hypoparathyroidism occurred in 22% (bilateral FS-CND) and 23% (unilateral FS- চাহিদা). Permanent hypoparathyroidism was 1% (bilateral) and 2% (unilateral).
  • Transient RLN palsy occurred in 15% (bilateral FS-CND) and 14% (unilateral FS-CND), with no permanent cases in the bilateral group and one permanent case in the unilateral group.
  • Control group showed 21% transient and 1% permanent hypoparathyroidism, and 9% transient and 2% permanent RLN palsy.

Conclusions:

  • The overall permanent morbidity from FS-CND in this series was low (1%).
  • FS-CND may be recommended, even prophylactically, for experienced, high-volume surgeons in patients with thyroid nodules suspicious for malignancy.