When is surgery indicated for recurrent thyroid cancer?
Suspected recurrent disease in the neck should be evaluated by using FNA. Confirmed nodal recurrence should be treated with a formal dissection of the involved neck compartment. A recurrence in a neck compartment that has already been subjected to formal neck dissection can be challenging because of scarring of the tissue planes, which renders repeat formal neck dissection virtually impossible. In these situations, the risks and benefits of additional surgery must be carefully considered because the risk of complications increases and the likelihood of cure decreases with each subsequent surgery for recurrence. Observation may be the best option for patients with low-risk disease. When indicated, focused resection of nodal recurrences that are palpable can be performed. If not palpable, intraoperative ultrasonography can be used to guide the excision. For patients who are poor surgical candidates or have had multiple neck operations, percutaneous ethanol injection of nodal metastases is an alternative. Radioiodine is the standard therapy for distant metastatic disease, but isolated metastases can occasionally be surgically resected or treated with external beam radiation.