Main Article Content
Objective: Multinodular goiter is a common surgical disease. There is no common consensus regarding the extent of thyroidectomy for multinodular goiter. This study aims to present personal experience on treating patients with multinodular goiter and to compare complication rates and results of total and partial thyroidectomy for multinodular goiter.
Material and Method: Three hundred fifty patients underwent thyroidectomy for multinodular goiter between May 2003 and October 2010. All patients were diagnosed as multinodular goiter and were referred to surgery by one endocrinologist. All operations were also performed by one surgeon using microsurgical techniques. Partial thyroidectomy (bilateral subtotal or unilateral total thyroidectomy and contralateral subtotal thyroidectomy) was performed in 65 patients (Group-1) and extracapsular total thyroidectomy was performed in 285 patients (Group-2). All patients are being followed followed from the day they were diagnosed until now by the same endocrinologist. Fisher exact test was used for statistical analysis.
Results: In Group-1, one patient had transient vocal-cord palsy and but none had hypoparathyroidism. On the other hand, in Group-2, two patients had transient vocal-cord palsy, five had hypocalcemia (one was permanent), and one had a hematoma. Mortality and wound infection were absent in both groups. The histopathological studies showed that 40 incidental thyroid carcinomas occurred among Group-2 patients. During long-term follow-up, 13 patients had goiter recurrence (n = 65, 20%) in Group-1, whereas none had goiter recurrence in Group-2.
Conclusion: There were no statistically significant differences in the complication rate between subtotal and total thyroidectomy groups (p>0.05). However, the recurrence rate was higher (statistically significant) after subtotal thyroidectomy than after total thyroidectomy (p<0.05). Total thyroidectomy eliminated future recurrence of the disease and is also curative in incidental thyroid carcinomas. In addition, it can be safely performed using microsurgical techniques.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
2. Torre G, Barreca A, Borgonovo G et al. Goiter recurrence in patients submitted to thyroid-stimulating hormone suppression: possible role of insulin-like growth factors and insulin-like growth factor-binding proteins. Surgery 2000;127:99–103.
3. Bellantone R, Lombardi CP, Bossola M, et al. Total thyroidectomy for management of benign thyroid disease: review of 526 cases. World J Surg 2002;26:1468–1471.
4. Rios A, Rodriguez JM, Galindo PJ et al. Surgical treatment of multinodular goiter in young patients. Endocrine 2005;27:245–252
5. Delbridge L. Total thyroidectomy: the evolution of surgical technique. Aust N Z J Surg 2003; 73:761–768
6. Dralle H, Lorenz K, Machens A. Verdicts on malpractice claims after thyroid surgery: Emerging trends and future directions. Head Neck 2012;4(11):1591–1596
7. Thomusch O, Sekulla C, Dralle H. Is primary total thyroidectomy justified in benign multinodular goiter? Results of a prospective quality assurance study of 45 hospitals offering different levels of care. Chirurg 2003;74:437–443
8. Sosa J, Bowman H et al. The Importance of surgeon experience for clinical and economic outcomes from thyroidectomy. Ann Surg 1998;228:320–330
9. Efremidou E, Papageorgiou M, Liratzopoulos N, Manolas K. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases. Can J Surg 2009;52(1):39–44
10. Giles Y, Boztepe H, Terzioglu T, Tezelman T. The advantage of total thyroidectomy to avoid reoperation for incidental thyroid cancer in multinodular goiter. Arch Surg 2004;139:179–182
11. Reeve T, Delbridge L, Cohen A, Crummer P. Total thyroidectomy: The preferred option for multinodular goiter. Ann Surg 1987;206(6):782–786
12. Vaiman M, Nagibin A et al. Subtotal and near total versus total thyroidectomy for the management of multinodular goiter. World J Surg 2008;32:1546–1551
13. Cao H, Han J. Meta-analysis of total thyroidectomy for multinodular goiter. Zhong Nan Da Xue Bao Yi Xue Ban 2014;39(6):625–631
14. Agarwal G, Aggarwal V. Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter? An evidence-based review. World J Surg 2008;31(13):1313–1324
15. Miller MC, Spiegel JR. Identification and monitoring of the recurrent laryngeal nerve during thyroidectomy. Surg Oncol Clin N Am 2008;17(1):121–144
16. Dequanter D, Charara F, Shahla M, Lothaire P. Usefulness of neuromonitoring in thyroid surgery. Eur Arch Otorhinolaryngol 2015;Oct;272(10):3039-43.
17. Alesina PF, Hinrichs J et al. Intraoperative neuromonitoring for surgical training in thyroid surgery: its routine use allows a safe operation instead of lack of experienced mentoring. World J Surg 2014;38(3):592–598
18. Nielsen T, Andreassen U, Brown C, Balle V, Thomsen J. Microsurgical technique in thyroid surgery—a 10-year experience. J Laryngol Otol 1998;112(6):556–560
19. Saber A, Rifaat M, Ellabban G, Gad M. Total thyroidectomy by loupe magnification: a comparative study. Eur Surg 2011;41(1):49–54
20. Pata G, Casella C, Mittempergher F, Cirillo L, Salemi B. Loupe magnification reduces postoperative hypocalcemia after total thyroidectomy. Am Surg 2010;76(12):1345–1350
21. Testini M, Nacchiero M et al. Total thyroidectomy is improved by loupe magnification. Microsurgery 2004; 24(1):39–42
22. Ono K, Lindsey ES. Improved technique of heart transplantation in rats. J Thorac Cardiovasc Surg 1969;57:225–229
23. Kamada N, Calne RY. Orthotopic liver transplantation in the rat. Technique using cuff for portal vein anastomosis and biliary drainage. Transplantation 1979;28:47–50
24. Snook K, Stalberg P et al. Recurrence after total thyroidectomy for benign multinodular goiter. World J Surg 2007;31:593–598
25. D’Andrea V, Cantisani V et al. Thyroid tissue remnants after “total thyroidectomy” G Chir 2009;30(8-9):339–344
26. Karakoyun R, Bulbuller N et al. What do we leave behind after near total and subtotal thyroidectomy: just the tissue or the disease? Int J Clin Exp Med 2013;6(10):922–929
27. Delbridge L, Guinea A, Reeve T. Total thyroidectomy for bilateral benign multinodular goiter: effect of changing practice. Arch Surg 1999;134:1389–1393
28. Uccheddu A, Cois A, Licheri S. The choice of the intervention in the surgical treatment of nontoxic diffuse multinodular goiter. Minerva Chir 1996;51:25–32
29. Pappalardo G, Guadalaxara A, Frattarolli F et al. Total versus subtotal thyroidectomy in benign nodular disease: personal series and review of published reports. Eur J Surg 1998;164:501–506
30. Smith JJ, Chen Xi et al. Cancer after thyroidectomy: a multi-institutional experience with 1,523 patients. J Am Coll Surg 2013;216(4):571–579
31. Hamburger JL, Hamurger SW. Declining role of frozen section in surgical planning for thyroid nodules. Surgery 1985;2:307–312
32. Akhtar S, Awan MS. Role of fine needle aspiration and frozen section in determining the extent of thyroidectomy. Eur Arch Otorhinolaryngol 2007;264(9):1075–1079