Recurrent and Revision Surgery

Thyroid cancer presents certain unique challenges in surgery. Revision surgery for thyroid cancer presents even greater challenges, due to scarring and anatomical distortion from previous surgical procedure(s). Revision thyroid surgery has been associated with higher rates of complication, including recurrent laryngeal nerve paralysis (with a potential impact on voice and breathing) and parathyroid insufficiency (with an impact on calcium metabolism), as compared to first time surgery for thyroid cancer. Revision surgery for thyroid cancer is an area of specific expertise for our surgeons in the Thyroid Division at Mass. Eye and Ear. Such surgery may be necessary, as over time, up to 20 percent of patients with initial thyroid cancer may subsequently develop recurrent disease in the form of neck lymph node metastases. 

With expertise in head and neck surgical oncology, extensive knowledge of parathyroid glands and recurrent laryngeal nerve anatomy, and expertise in the management of surrounding cancerous lymph nodes (nodal metastases), our thyroid physicians offer the best care available for these challenging cases. Furthermore, they are joined in this multidisciplinary effort to treat thyroid malignancy by collaborators from the Departments of Radiology, Medical Endocrinology, Oncology, Radiation Oncology, Pathology and Cytopathology, Speech and Swallowing Therapy, and Laryngology.

Managing Recurrent Thyroid Cancer

The management of recurrent thyroid cancer begins with the preoperative evaluation. This includes a full physical examination of the head and neck region and of the voice box and vocal cords in an office setting. 

Our physicians have established and popularized a unique methodology for preoperative evaluation of recurrent thyroid cancer management that includes a combination of high-resolution ultrasound and fine-cut CT scanning of the neck to make a 3-dimensional map of the thyroid cancer and any lymph node neck metastases. Additionally, the surgeon often formulates a collaborative plan in consultation with the patient’s medical endocrinologist prior to surgery. 

When there is evidence of recurrent thyroid cancer with lymph node metastases, the treatment is often surgical. Our surgeons use nerve monitoring technology that was pioneered at Mass. Eye and Ear to preserve voice function and to prevent postoperative breathing and swallowing issues during these procedures. Intraoperative ultrasound is also available and is used to detect specific lymph node metastases. This is especially important because of scarring and distortion of the surgical field from previous surgery. 

The surgery is typically performed through the previous incision and involves an overnight stay in the hospital. Because of this expertise and the extremely favorable published outcomes, our Division is one of the highest volume centers for such surgeries in the United States.

Scientific Resources

  • Dr. Gregory Randolph published a study of 117 surgeries for recurrent thyroid cancer in patients who underwent a second, third, fourth, fifth, sixth, or seventh cancer surgery at Massachusetts Eye and Ear. The studied showed a 0% rate of neural complications.
  • Dr. Gregory Randolph published a radiographic algorithm that supports accurate definition of lymph node metastasis for patients with the most common type of thyroid cancer called papillary carcinoma both in primary surgery and revision surgery.
  • Dr. Gregory Randolph has also published, on behalf of the American Thyroid Association, a review paper outlining the importance of radiographic recognition of macroscopic nodal disease.
  • Our physicians have published an article on evidence based treatment of high-thyroid cancers such as poorly differentiated thyroid cancer.
  • Dr. Gregory Randolph and Dr. Dipti Kamani have done extensive work on the importance of laryngeal exam prior to thyroid surgery.