Revision thyroid surgery - technical considerations.

Reoperative thyroid surgery is a technical challenge with a high incidence of complications and recurrent disease. It requires a thorough understanding of the anatomy and biology of the disease process, expertise in surgical technique, and avoidance of complications related to recurrent laryngeal nerve and parathyroid glands. Preoperative evaluation includes review of previous surgical procedures and pathology reports and evaluation of the extent of the disease with appropriate imaging studies. Preoperative evaluation of the vocal cord and vocal cord function is vitally important. Postoperative adjuvant treatment with radioactive iodine or external radiation therapy should be considered in selected individuals. Proper histologic evaluation of the recurrent thyroid tumor is important, to rule out poorly differentiated thyroid carcinoma. Despite good surgical resection, the incidence of local recurrence in the central compartment is high in patients undergoing reoperative thyroid surgery.