Morbidity of completion thyroidectomy for initially misdiagnosed thyroid carcinoma

We reviewed 757 cases of thyroid carcinoma treated between 1963 and 1986 to investigate the morbidity associated with completion thyroidectomy when a nodule initially reported to be benign by frozen section is subsequently found to be malignant; 66 patients underwent completion thyroidectomy as a second procedure for initially misdiagnosed thyroid carcinoma. Fifty-one patients had papillary carcinoma, 12 follicular carcinoma, and 3 Hürthle cell carcinoma. Final pathology revealed 28 cases of multicentricity of which 19 were bilateral. Complications included transient hypocalcemia (12.1%), recurrent laryngeal nerve palsy (1.5%), and wound hematomas or infections (9.1%). No cases of permanent hypoparathyroidism or vocal cord paralysis were encountered. Reoperation for initially misdiagnosed thyroid carcinoma appears to be warranted in light of the low morbidity and high incidence of bilateral and multicentric disease reported in this series.