الفهرس 
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Abstract
The resection of an enlarged remnant gland and reoperations in the thyroid bed are surgically challenging because of the distortion of anatomic planes and scarring from prior surgery. Thyroid reoperations can be challenging, even for a highly experienced thyroid surgeon, as visual identification of the RLN is more difficult during dissection of scar tissue than in the virgin neck. Patients and Methods: Our patients were 60 patients and they were classified them into three main groups: group I : (20 patients) underwent total thyroidectomy. group II: (20 patients) underwent early re do in thyroid surgeries. group III: (20 patients) underwent late re do in thyroid surgeries. Inclusion criteria: Primary total thyroidectomy patients with follow up for one year and not in need for re do surgery. Patients with hemi thyroidectomy since 2 to 6 weeks that underwent Completion thyroidectomy for errors in pathological report or the post-operative paraffin examination shows malignant criteria. (Early re-do) recurrence symptoms after previous thyroid surgery (Late re-do: recurrent thyroidectomy) as Patients with late Recurrence after subtotal thyroidectomy. Recurrence after total thyroidectomy with trace thyroid tissue residual (near total thyroidectomy).Recurrence after hemi thyroidectomy. Age between 31-69 years. Both genders were included. Exclusion criteria: Patients with recurrent congenital or inflammatory thyroid disease. Patients with vocal cord problems. Patients with proven metastatic thyroid carcinoma.
All patients were submitted to: Full medical history, General and local examination, Radiological, Laboratory, Cytological investigations, Investigations were done to all patients like: Thyroid function tests (Serum T3, T4 and TSH). CBC, INR, Liver function tests and Serum Creatinine to assess effect of disease on it & as pre-operative preparation , E.C.G , Neck U/S & Duplex : Special probe to give idea about the nodule, (solid, cystic, size, homogenous, heterogeneous, well defined, ill defined, vascularity, infiltration to surrounding structures and retrosternal extension), Preoperative F.N.A.C (cytological examination), Post-operative pathology. Results: total thyroidectomy was done for all patients of group1 of total thyroidectomy as a primary operation or Primary total thyroidectomy with cherry picking dissection to knows its results and the effect of it about the incidence of recurrence with follow up one year, completion thyroidectomy was done for all patients (20) of group of early re do in thyroid surgeries but patients with papillary thyroid carcinoma had completion thyroidectomy with cherry picking of LNs and patients with follicular thyroid carcinoma had completion thyroidectomy with block neck dissection but all the patients of group of late re do in thyroid surgeries had recurrent total thyroidectomy except 2 patients had total thyroidectomy with cherry picking of LNs., all the patients had completely mobile vocal cords 3 Months post primary total thyroidectomy, early and late re do surgery and we found only a case with permanent stridor and with tracheostomy post recurrent thyroidectomy in group of late re do. In our result, there were 2 cases with hypocalcaemia post 3months follow up (one in each group of total thyroidectomy and early re do surgery) and 3 cases with hypocalcemia in group of late re do, post 6 months hypocalcemic manifestations there was only a case with hypocalcemia in group of late re do and with follow up after a year there still was the same case with hypocalcemic (permanent hypocalcemia). In our result, there were 2 cases had bleeding and hematoma post recurrent thyroidectomy so we had treated them in operative room to control bleeding. In our result, we found 8 cases of 60 cases had complications of scar about 4 cases had keloid scar and 4 cases had hyperemic scar post recurrent thyroidectomy. In our results, post 3, 6 months there were only a patient in group of primary total thyroidectomy, 2 patients about (10%) of group of early re do and 3 patients in late re do with hypothyroidism and although all the patients were on hormonal replacement therapy (Eltroxine tab) and we increase the dose for patients with hypothyroidism. So we found that there were 2 cases had hypothyroidism post 1 year with follow up and on hormonal replacement therapy (Eltroxine tab) with history of those patient that many times missed tablets. Conclusion: from this study it is shown that total thyroidectomy is advised to be done in all patients with thyroid diseases as there was no recurrence detected and to avoid complications that may be present in re do surgery.To guard against performance of completion thyroidectomy, U/S examination and FNAC should be taken from different sites.