Indications for reoperative thyroid surgery: Application of modern diagnostic techniques

Abstract

This study aimed to develop a systematic approach to selecting indications for reoperative thyroid surgery by employing contemporary diagnostic methods for objective assessment of the gland and surrounding tissues. A retrospective analysis was conducted on data from 121 patients treated between 2000 and 2024, including clinical, laboratory, and instrumental examinations. The cohort predominantly comprised women (94.2%) with a mean age of 47.6 years. Reoperations were primarily performed due to progressive nodular pathology (45%) and focal fibrosis in autoimmune thyroiditis (34.7%), whereas malignant tumour recurrence was observed in 8.3% of cases. Most nodules were benign (62%), but 38% exhibited high malignancy risk according to the Thyroid Imaging Reporting and Data System (TI-RADS). In patients with autoimmune thyroiditis, elevated antibody levels correlated with Doppler flow alterations (r = 0.68; p < 0.01), serving as a disease activity marker. Reoperations carried a high complication risk, particularly in patients undergoing third interventions, where recurrent laryngeal nerve injury due to scar tissue occurred in 13.3% of cases. Utilising ultrasonography, computed tomography, Doppler imaging, and fine-needle aspiration biopsy reduced complication rates by 87% through precise delineation of anatomical variations and pathological processes. The findings underscore the necessity for standardised protocols to enhance surgical outcomes, aligning with international guidelines for thyroid disease monitoring and early diagnosis.