Risk Factors for Recurrent Nodular Goiter after Thyroidectomy for Benign Disease: Case‐control Study of 244 Patients

Abstract

Surgery for recurrent nodular goiter is associated with a significant risk of parathyroid and recurrent laryngeal nerve (RLN) morbidity. Total thyroidectomy for benign disease is assessed. The aim of this study was to evaluate the risk factors for recurrence and the morbidity associated with reoperation. From 1969 to 1996 a total of 4334 thyroidectomies were performed, of which 122 were for recurrent nodular goiter (group I: 116 women, 6 men). A matched case-control study of 122 patients operated on for nonrecurrent multinodular goiter was performed (group II: 112 women, 10 men). Age, family history, initial surgery, pathology, and morbidity were compared in the two groups by chi2 test, Fisher's exact test, and the Mantel-Haenszel test. The mean age was 39.88 years in group I and 47.89 years in group II. There was no statistical difference in relation to the extent of thyroidectomy or morbidity after initial surgery. Statistical differences were identified regarding age (p = 0.000002) and the multinodular nature of the initial goiter (p = 0.005). Bilaterality and family history were less significant (p = 0.09 andp = 0.08, respectively). Temporary RLN palsy and temporary hypoparathyroidism were higher in group I (12.3% vs. 5.7%,p = 0.0737; 10.6% vs. 1.7%, p = 0.00337). Permanent RLN palsy was found in 0.8% in group I and in none in group II (p = 0.5, NS). Young age and multiple nodules at initial surgery are risk factors for recurrence. A higher rate of temporary morbidity was demonstrated after surgery for recurrent goiter. Total thyroidectomy for multinodular goiter is advisable.

Treatment of Benign Thyroid Nodules: Comparison of Surgery with Radiofrequency Ablation

“…surgery has a high incidence of complications such as recurrent laryngeal nerve injury, hypoparathyroidism, and hypothyroidism 3,4,29,30 ; however, the complication rate reported for RFA was low in the study by Baek et al, 25 a 3.3% complication rate with thyroid RFA in their multicenter study. In our current study, the RFA complication rate was found to be lower than that of surgery.…”

“…Thus, surgery has been advocated by some clinicians, but after resection of the nodules, patients often have neck scars or hypothyroidism, which seriously affects their quality of life. 3,4 Additional issues include the risks of general anesthesia and postoperative parathyroid function abnormalities. [1][2][3]5 Therefore, minimally invasive alternatives have been explored.…”

“…3,4 Additional issues include the risks of general anesthesia and postoperative parathyroid function abnormalities. [1][2][3]5 Therefore, minimally invasive alternatives have been explored. Ethanol ablation, laser ablation, microwave ablation, and radiofrequency ablation (RFA) are safe and effective techniques for the treatment of nodular goiter.…”

Image-guided thermal ablation of benign thyroid nodules

“…Whereas thyroid surgery is widely available and safe in many centers, it still carries a 2-10 % risk of complications, such as neck scarring, hypothyroidism, postoperative hypoparathyroidism, recurrent laryngeal nerve injury, and the risks associated with general anesthesia. Surgery is also expensive, and may not be appropriate for a surgically high-risk individual [10,[25][26][27][28][29][30]. Over the last decade, thermal ablation techniques, such as laser ablation (LA), radiofrequency ablation (RFA), high-intensity-focus ultrasound (HIFU), and microwave ablation (MWA), have been proposed for the treatment of benign solid thyroid nodules, with encouraging results.…”

Reoperative Thyroid Surgery - Our Experience

“…It was thought to be a safe procedure. Risk of recurrent goiter after subtotal thyroidectomy, which ranges from 3% to 43 % (1)(2)(3) . Suppression of TSH L-thyroxin therapy can be used to prevent the recurrence and is useful only in 30 % of patients (1,(4)(5)(6)(7)(8)(9) .…”