World J. Surg. Vol. 16, No. 1, Jan./Feb. 1992
130
Table 3. Thyroid
operations).
operations
Total
Diagnosis
Carcinoma’
Atypical?
Benign
Total
performed
Almost
in the
Marshallese (80
thyroidectomy
total
subtotal
Bilateral
Single
lobe
excision
Local
10
2°
I
13
6
3¢
5
14
4
2
23°
29
3
4
10
17
0
0
7
7
“Based on the opinion of pathology panel.
’Does not include atypical tesions accompanying carcinomas.
“One patient was reoperated for regrowth following bilateral subtotal thyroidectomy 10 years earlier.
“Two patients were reoperated for regrowth following bilateral
subtotal thyroidectomy 10 years earlier.
“Includes a previous bilateral subtotal thyroidectomy for benign
adenomas.
minute adjacent piece of thyroid capsule to preserve the blood
supply to that parathyroid. However, such a procedure was
essentially a total removal ofall thyroid tissue (Table 3). Among
77 cases operated only one lobe was removedin 17 patients. In
6 patients where carcinoma was suspected and in 3 patients
where carcinoma was found only one lobe wastotally removed
because of advanced age. physical disability, or doubtful frozen
section diagnosis. Among the remaining 29 cases where the
presumptive diagnosis was adenoma(s) a bilateral subtotal
thyroidectomy was done, preserving non-nodulartissue. Local
excision was performed in 7 patients.
The more extensive dissections required individual variations
in the management ofthe parathyroids. At least 3 parathyroids
were identified in each case. Transplantation was required in 2
cases (2 in | case; | in another). It was customaryto salvage for
transplantation any parathyroids lying in close proximity to
positive nodes on the surgical specimen. These weresliced very
thin, leaving the capsule intact on oneside, and placing it under
the skin over the sternum where the site could be palpated
thereafter. Amongall of the operations by 3 different surgeons,
there has been | case of permanent hypoparathyroidism di-
Fig. 3. An infiltrating (primarily) follicular carcinoma in a 38 year old
female exposed on Rongelap at age 16. The primary lesion was 0.8 cm.
Lymph nodes were involved. This represents 1 of 5 cases with one or
more positive lymph nodes in which the primary lesion was 1] cm orless
in diameter. (*75).
recuy attributable to the surgery and a second case in which
asymptomatic hypocalcemia developed after the patient had
been normocalcemic for 20 years following the surgery. Both
anterior and posterior mediastinum, was performed. If positive
suspected and a total thyroidectomy had been undertaken.
There have been no recurrent laryngeal nerve injuries. There
ately adjacent to the contralateral lobe were also removed and
inspected. There were 8 cases in which one or more lymph
years following exposure and 27 years following the first
found and it was lying adjacent to the thyroid. In the remaining
5 cases multiple positive nodes were found in the jugular and or
upper mediastinal areas. They were unilaterally abundant in 3
cases and bilateral in one case. In 5 of the 8 cases the primary
cases were among thefirst 3 operated; carcinoma had been
have been no recurrences of carcinoma as of March 1991 (37
surgery).
Precise direct measurementof the size of the carcinomas on
the surgical specimen or on microscopic sections showedthat
the sizes ranged from microscopic to 3.4 cm. There were 12
patients in which the largest carcinoma was <1I.0 cm in diam-
eter, in 2 patients it was 1.0 cm, andin 8 patients it was >1.0
cm. In one patient the size of the lesion was not recorded.
Lymph Node Involvement
ey
or
Po 3
St
ar
Where a diagnosis of carcinoma was made orstrongly suspected after the initial total lobe was removed, an extensive
lymph node dissection on the same side, including the upper
a node wasfound onthefirst side, the regional nodes immedinodes werepositive. In 3 cases there was but one positive node
lesion was 1.0 cm or less in diameter. In one unexposed
individual from Utirik, born 1 year and 4 monthsfollowing the
accident, the initial mass had been excised elsewhere but it’s
diameter had not been recorded. At the second operation by the
author (BMD), there were extensive lymph nodes involved.
Underthe circumstances the primary probably was >1 cm. It is
very significant that of 14 cases where the primary carcinoma
was | cm orless, in 5 patients the disease had already spread.
There has been no evidence of distant metastases in any case.
Thesefindings show that, where surgery happened to have been