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Incidental Thyroid Cancer Found during Surgery for Head and Neck Squamous Cell Carcinoma

Objective: We aim to determine the clinical significance of incidental thyroid cancer found during surgery for HNSCC. We examined the clinical outcome of these patients with regard to both HNSCC and thyroid cancer to determine the need for treatment of incidental thyroid disease. Method: Using our head and neck cancer registry, we retrospectively reviewed 2,538 neck dissections performed at our institution over a 15-year period. We identified 29 patients who had an incidental pathologic finding of thyroid disease at surgery. We reviewed demographics, diagnoses, histopathology, initial and subsequent management, and outcome. Results: Papillary thyroid cancer was the principal thyroid cancer in every case in our cohort. Fifteen patients died during the period of the study (2.4-year mean follow-up), with 14 patients still alive (4.3-year mean follow-up). Seven patients received further treatment for their thyroid: 2 with completion thyroidectomy, 2 with I-131 ablation, and 3 with both. During the follow-up period, none of the patients developed tissue proven recurrence of thyroid cancer. Cause of death was unrelated to thyroid cancer in all of the patients who died during the follow-up period. Conclusion: Thyroid cancer, in general, has excellent prognosis. This study suggests that further management of occult thyroid cancer discovered in patients undergoing surgery for HNSCC may not be necessary.