Optimal surgical treatment for bilateral multinodular goitre

Abstract

Objective: In the present study, we compared subtotal thyroidectomy (STT) with total thyroidectomy (TT) in the management of bilateral multinodular goitre. Methods: A total of 204 consecutive patients with bilateral multinodular goitre were assigned to have either TT (n = 73) or STT (n = 131). Demographic details, hospital stay, biochemical findings, indications for operation and complications were noted. Results: There was no significant difference in the age and sex ratio between the two groups (P = 0.695 and P = 0.733). According to thyroid functional status, the majority of patients were euthyroid in both groups (73.28% vs 84.90%). Goitre grades II and III presented the most common indication for STT and TT. Hospital stay for patients who underwent TT was significantly longer compared to STT (P < 0.001). There was no significant difference in the rate of permanent complications. Conclusions:In the present study, we have shown that the risk of permanent complications with TT is no greater than with STT.

Total or Subtotal Thyroidectomy in the Management of Multinodular Goiter

“…The toxic manifestations and suspected cancer are less common indications. The indications for surgery are presented in Table (2).…”

“…2007 and Barakate M. S. 2002 and in their studies. 2,22 According to these results, we suppose that encountering the recurrent laryngeal nerve by use of the capsular technique of dissection and identifying the nerve close to the lateral thyrohyoid ligament is potentially safer than leaving it buried beneath residual posterior thyroid tissue while trying to achieve haemostasis of that residual tissue. Certainly, haemostasis is better achieved after total thyroidectomy when all vessels have been individually ligated outside the gland than when dealing with residual vascularized thyroid tissue.…”

“…These results disagree with that of Colak T. and his colleagues 2004 and agree with that of Karanikolic A. and his colleagues 2007. 1,2 This diversity in results may be due to different surgical techniques and different surgeons' experiences.…”

“…1 Thyroidectomy remains the treatment of first choice for these patients with multinodular goiter especially with suspected malignancy and large-sized goitre causing symptomatic compression. 2 The procedure of thyroidectomy was developed by Theodore Kocher and William Halsted. 3 Since that time in the last century, it has developed from a life-threatening intervention to an efficient, wide-spread, and safe procedure nowdays.…”

“…However, in recent years, function and morphology-orientated surgery has been favoured. 2 In 1997 Korun and his colleagues reported that 40% of the patients with multinodular goitre have nodules localized in the dorsal part of the gland, which are usually left during normal subtotal resection. 5 Recently, total thyroidectomy has replaced bilateral subtotal thyroidectomy as the preferred option for the management of all patients with bilateral benign multinodular goitre, Graves' disease, all types of thyroid cancer 6 and other less common conditions, such as thyroiditis and Amiodarone-induced thyrotoxicosis.…”