Is Total Thyroidectomy the Surgical Procedure of Choice for Benign Multinodular Goiter? An Evidence‐Based Review

Agarwal, Gaurav; Aggarwal, Vivek

doi:10.1007/s00268-008-9579-8

Cited by 184 publications

(185 citation statements)

References 61 publications

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“…It is reported that differentiated thyroid cancer may be detected in up to 10% of patients undergoing surgical procedures for benign thyroid disease, in post-operative histopathological evaluation (8,9). In the literature, completion thyroidectomy is recommended for such cases (10,11).…”

Section: Discussionmentioning

confidence: 99%

Completion thyroidectomy in differentiated thyroid cancer: When to perform?

Kısaoğlu

Özoğul

Akçay

et al. 2014

UCD

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Objective: Completion thyroidectomy is recommended in patients who have been diagnosed with differentiated thyroid cancer on histopathological evaluation, if their first operation was a conservative approach. The critical issue is when to do the second operation. Material and Methods:The medical records of 66 patients who underwent completion thyroidectomy for the treatment of differentiated thyroid cancer in our clinic between 2006-2013 were retrospectively analyzed. All data were compared after patients were divided into two groups according to the interval between the first surgery and completion thyroidectomy.Results: Fifty-two patients (78.8%) were women and 14 patients (21.2%) were male. Completion thyroidectomy was performed 10-90 days after the initial surgery (group 1) in 26 patients, whereas it was performed later than 90 days in 40 patients (group 2). Temporary hypoparathyroidism occurred in two patients (7.7%) in group 1, and in 3 patients (7.5%) in group 2. Transient recurrent laryngeal nerve palsy was observed in 1 patient (3.9%) in group 1, and in 1 patient (2.5%) in group 2. There were no permanent morbidities in both groups. Residual tumor rate after completion thyroidectomy was 45.5%. There was no statistically significant difference between the two groups in terms of complications after completion thyroidectomy. Conclusion:Although in some studies it is recommended that completion thyroidectomy should be performed either before scar tissue development or after clinical remission of scar tissue, edema and inflammation, we believe that timing of surgery has no effect on morbidity.Key Words: Thyroid cancer, thyroidectomy, intraoperative complication, repeat surgery INTRODUCTIONAlthough the type of surgery in the treatment of differentiated thyroid cancer (DTC) is still being debated, in recent years many authors recommend total thyroidectomy in these patients with good prognosis due to the metastasis potential, even though it is rare (1, 2). Udelsman and Shaha (3) advocate total thyroidectomy stating that with limited surgery the risk of recurrence, reoperation and morbidity increase and that radioactive iodine (RAI) ablation occurs at lower doses. In contrast, some authors suggest conservative approaches based on the findings that risk of anaplastic transformation is below 1%, multicentric tumors do not significantly affect the clinical course, and in limited surgery; RAI therapy is possible with lower morbidity, the prognosis does not change and the complication rate is lower (4, 5). Similarly, although what needs to be done in patients pathologically diagnosed with DTC and in whom a conservative approach had been preferred during the first surgery is still controversial, a completion thyroidectomy is often suggested in high-risk patients in order not to leave any thyroid tissue behind (6, 7). The critical point is the timing of the second operation.In our study, we retrospectively evaluated patients who underwent completion thyroidectomy for DTC with emphasis on the importance of timing of the...

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Section: Discussionmentioning

confidence: 99%

Completion thyroidectomy in differentiated thyroid cancer: When to perform?

Kısaoğlu

Özoğul

Akçay

et al. 2014

UCD

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“…Several assumptions led to this widely shared behavior. The major reasons included the following: low complication rate associated with TT (as reported by several authors) [27][28][29], risk of relapse after hemithyroidectomy [5,7], risk of an occult malignancy [30] that makes follow-up complex, and/or greater difficulty in performing the revision surgery after thyroid lobectomy. Several recent studies have emphasized various advantages of hemithyroidectomy [31,32] in selected cases of malignancy [33,34].…”

Section: Discussionmentioning

confidence: 99%

“…TT was used as a surgical treatment for a wide range of thyroid diseases including solitary benign nodules [6,26,27]. Several assumptions led to this widely shared behavior.…”

Section: Discussionmentioning

confidence: 99%

The prevalence of post-thyroidectomy chronic asthenia: a prospective cohort study

Scerrino¹,

Raspanti²,

Attard³

et al. 2017

Langenbecks Arch Surg

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Purpose Chronic asthenia (CA) is complained by some patients that have undergone thyroid surgery. We evaluate its impact in patients undergoing unilateral or bilateral thyroidectomy, the trend during a 1-year follow-up, and the possible risk factors. Methods A prospective, cohort study was carried out on 263 patients scheduled for thyroidectomy from 2012 and 2014. Exclusion criteria were as follows: Graves' disease, malignancies requiring radioiodine therapy, post-surgical hypoparathyroidism, laryngeal nerve palsy, abnormal pre-and postoperative thyroid hormone levels, and BMI outside the normal range. Demographics; smoking and alcoholism addiction; cardiac, pulmonary, renal, and hepatic failure; diabetes; anxiety; and depression were recorded. The Brief Fatigue Inventory (BFI) was used to evaluate CA and its possible association with these comorbidities 6 and 12 months after thyroidectomy. Results One hundred seventy-seven patients underwent total thyroidectomy (TT), 54 hemithyroidectomy (HT). Thirty-two patients were not recorded because of the onset of exclusion criteria. In the 6 months after thyroidectomy, in the TT group, 64 patients (36.16%) reported an impairment in the BFI score and only 1 in the TL group. The mean BFI score changed from 1.663(±1.191) to 2.16 (±11.148) in the TT group, from 1.584 (±1.371) to 1.171 (±1.093) in the TL group (p < 0.001). No further significant variations in BFI were reported 1 year after surgery. Conclusions CA worsened after TT, but not after HT. Apart from operative procedure itself, no other risk factor was found be significantly associated with post-thyroidectomy asthenia. Further investigation is needed to determine the causes of CA.

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“…Given these disadvantages, it is controversial whether there is a benefit in terms of postoperative complications compared to total thyroidectomy [22,23].…”

Section: Surgical Treatmentmentioning

confidence: 99%

Diagnostic, therapeutic and health-care management protocol in thyroid surgery: a position statement of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB)

Rosato

Crea

Bellantone

et al. 2016

J Endocrinol Invest

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members, via e-mail, in the elaboration phase; all the participants of the XI National Congress of the U.E.C. CLUB held in Naples in the final phase. The following were examined: diagnostic pathway and clinical evaluation; mode of admission and waiting time; therapeutic pathway (patient preparation for surgery, surgical treatment, postoperative management, management of major complications); hospital discharge and patient information; outpatient care and follow-up. Results A clear and concise style was adopted to illustrate the reasons and scientific rationales behind behaviors and to provide health-care professionals with a guide as complete AbstractPurpose The diagnostic, therapeutic and health-care management protocol (Protocollo Gestionale DiagnosticoTerapeutico-Assistenziale, PDTA) by the Association of the Italian Endocrine Surgery Units (U.E.C. CLUB) aims to help treat the patient in a topical, rational way that can be shared by health-care professionals. Methods This fourth consensus conference involved: a selected group of experts in the preliminary phase; all Electronic supplementary material The online version of this article

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Is Total Thyroidectomy the Surgical Procedure of Choice for Benign Multinodular Goiter? An Evidence‐Based Review

Abstract: Total thyroidectomy is the procedure of choice for the surgical management of benign multinodular goiter.

Cited by 184 publications

References 61 publications

Completion thyroidectomy in differentiated thyroid cancer: When to perform?

Completion thyroidectomy in differentiated thyroid cancer: When to perform?

The prevalence of post-thyroidectomy chronic asthenia: a prospective cohort study

Diagnostic, therapeutic and health-care management protocol in thyroid surgery: a position statement of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB)

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