Nontoxic Multinodular Goitre and Incidental Thyroid Cancer: What Is the Best Surgical Strategy?—A Retrospective Study of 2032 Patients

Abstract

Objectives A discussion with regard to the most optimal surgical procedure in nontoxic multinodular goitre (NTMNG). We assessed and compared three main types of operations in 2032 patients with NTMNG. Methods This is a retrospective study of 2032 patients operated on in one center due to NTMNG. The observation period was 48 to 120 months (mean and SD: 87 ± 20). Results The early complications included uni- and bilateral recurrent laryngeal nerve paralysis (URLNP, BRLNP), overt tetany (OT), and postoperative bleeding (POB). We observed after TT, STT, and DO URLNP: 15 (1.73%), 3 (0.64%), and 2 (0.28%), respectively (p < 0.05); BRLNP: 3 (0.34%), 2 (0.43%), and 0 (0.0%), respectively (p = 0.25); OT: 42 (4.84%), 6 (1.29%), and 9 (1.28%), respectively (p < 0.0001); and POB: 11 (1.26%), 4 (0.86%), and 3 (0.42%), respectively (p = 0.209). Persistent complications we observed after TT, STT, and DO are the following: URLNP: 9 (1.03%), 3 (0.64%), and 1 (0.14%), respectively (p = 0.086); BRLNP: 1 (0.11%), 1 (0.21%), and 0 (0.0%), respectively (p = 0.51); and OT: 11 (1.26%), 2 (0.43%), and 2 (0.28%), respectively (p = 0.052). Incidental thyroid cancer (ITC) was recognized after TT, STT, and DO in 18 (2.07%), 21 (4.52%), and 11 (1.56%), respectively (p = 0.039). Recurrent goitre (RG) was observed in 1 (0.11%) after TT, 3 (0.64%) after STT, and 2 (0.28%) after DO (p = 0.234). Conclusions Performing less radical surgery in NTMNG is associated with a significantly lower risk of early and late URLNP and OT. In the case of BRLNP (early and persistent) and POB, no statistically significant differences are seen. The occurrence of ITC is higher following more radical surgeries. Less radical surgery is connected with a higher risk of RG.

The occurrence of and predictive factors for multifocality and bilaterality in patients with papillary thyroid microcarcinoma

“…[1] However, lesions being 1.0 cm or less in the largest dimension known as papillary thyroid microcarcinomas (PTMCs), are responsible for a progressively higher rate of thyroid cancer during the last few decades. [1,2] According to our own experience, [3] the prognosis of PTMC is excellent; however, in cases of locoregional recurrences, worse oncological outcomes might be observed.…”

Incidental thyroid cancer in patients undergoing surgery for benign multinodular goitre: A retrospective clinical study

“…Especially when compared with primary TT; the rate of complications up to 5-10 times for permanent recurrent nerve paralysis and persistent hypoparathyroidism is quite striking [32][33][34]. On the other hand, no significant difference was reported between the patients who underwent TT for the first operation due to benign MNG and those who underwent subtotal thyroidectomy [35][36].…”

Thyroid incidentaloma as a “PAIN” phenomenon— does it always require surgery?

“…In our clinic, we warily recommend surgery for the patients with TI recognized in FDG-PET examinations, despite the increasing prevalence of thyroid cancer in general population [5,19,29,33] and the high incidence rate of malignancy in TIs localized by PET (up to 50%). [7,9] We are aware that physical status of the patients with “PAIN” phenomenon might be not well and “clinically complex.” Surgical treatment not necessary might be the optimal management in some individuals with “PAIN” phenomenon.…”

“…However, on the other hand we noticed that thyroidectomy conducted by the surgeons experienced in thyroid surgery is rather safe, so the risk of the malignant disease extension might be higher then the risk of the potential postsurgical complications. [33]…”