Importance of routine evaluation of the thyroid gland prior to open partial laryngectomy

Objectives: To determine the incidence and presentation of synchronous thyroid lesions in a patient population undergoing open partial laryngectomy ( OPL), and to determine whether routine preoperative evaluation of the thyroid gland prior to OPL is useful to identify synchronous thyroid lesions in order to reduce the need for reoperation in this complex patient population. Design: Retrospective medical chart review. Setting: Academic institution. Patients: Sixty- seven consecutive patients with laryngeal tumors who had undergone OPL from 1996 to 2005. Interventions: Charts of 67 consecutive patients with laryngeal tumors who underwent OPL in 1996 to 2005 have been reviewed for synchronous thyroid lesions. For all patients, reports of ( 1) complete preoperative examination findings, ( 2) inpatient course, ( 3) postoperative follow- up, and ( 4) postoperative final histopathologic findings were reviewed. For patients with synchronous thyroid lesions, reports of ( 1) thyroid evaluation and imaging and ( 2) preoperative ( fine- needle aspiration), ( 3) intraoperative ( frozen section), and ( 4) postoperative ( final) histopathologic results for the thyroid lesions were reviewed. Main Outcome Measures: Incidence of synchronous thyroid lesions and laryngeal cancer in patients undergoing OPL. Results: Eight ( 11.9%) of 67 ( 95% confidence interval, 5.3%- 22.2%) patients with laryngeal tumors who underwent OPL had evidence of synchronous thyroid lesions. All 8 patients had squamous cell carcinoma of the larynx and underwent either supracricoid or supraglottic laryngectomy. In these 8 patients, synchronous thyroid lesions were incidentally detected. Four patients had papillary thyroid carcinoma, 1 had squamous metaplasia, and 3 had follicular thyroid tissue that was negative for malignancy on final pathologic examination. In 2 patients, the thyroid lesions were detected preoperatively ( prior to OPL); in another 2 patients, thyroid masses were detected intraoperatively; and in 4 patients, the thyroid disease was identified postoperatively on histopathologic examination of excised cervical lymph nodes. In 2 patients, thyroidectomy was performed as a second operation after the OPL, and 1 of them had transient vocal fold paralysis for 2 months. Thyroid ultrasonography was performed in 4 patients. In 3 patients, the ultrasonography was performed after the OPL final pathologic findings indicated the presence of metastatic thyroid disease in cervical lymph nodes. Ultrasonography revealed intrathyroidal lesions in all 3 patients. Conclusions: Patients with laryngeal tumors who will be undergoing OPL might have occult synchronous thyroid lesions. Thyroid surgery in patients with previous OPL may have an increased potential for complication owing to postsurgical changes in the central neck region. Routine preoperative evaluation of the thyroid gland, especially with ultrasonography, to screen for occult synchronous thyroid lesions is recommended for all patients with laryngeal tumors who will be undergoing OPL. Eradication of any thyroid cancer detected preoperatively by fine- needle aspiration should be performed at the same time as OPL. Pros and cons of total thyroidectomy for indeterminate thyroid nodules should be discussed with this patient population.