Total Thyroidectomy versus Bilateral Subtotal Thyroidectomy for Bilateral Multinodular Nontoxic Goiter: A Meta-Analysis

Li, Yujie; Li, Yangjun; Zhou, Xiaodong

doi:10.1159/000444644

Cited by 19 publications

(17 citation statements)

References 38 publications

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“…Nontoxic goiter was commonly observed in females in the present study and this is in concurrence with literature. [6][7][8][9] The mean age of the patients in the present study was 33.3 years, correlating well with other studies. [9][10][11] The presence of goiter/ thyroid swelling as an inclusion criteria was observed in all patients with localized enlargement in 78% and generalized enlargement in 22% of patients.…”

Section: Discussionsupporting

confidence: 89%

Nontoxic goiter: causes, clinical evaluation and management

2018

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INTRODUCTIONThyroid diseases are the commonest endocrine disorders worldwide and India is no exception. It has been estimated that about 42 million people in India suffer from thyroid diseases.1 Recent population studies have shown that about 12% of adults in India have a palpable goiter and Indian government has earmarked the goiter endemic regions in the country. 2 The nontoxic goiter is divided on the etiological basis as endemic goiter and sporadic goiter. The endemic goiter is defined as one where more than 5% of the population shows thyroid enlargement. 3 The most common cause of goiter in goiter endemic areas is thought to be iodine deficiency but it is very difficult to establish the cause effect relationship in a hospital setting. The present study was carried out in a government notified endemic region to evaluate the nontoxic goiter patients for pattern of presentation, histopathological causes, with its surgical management and post-operative complications. ABSTRACTBackground: Thyroid diseases are the commonest endocrine disorders worldwide and India is no exception. Goiter may be generalized or localized, toxic or nontoxic. The present study is being carried out in a government notified endemic area to study the etiology and surgical management with postoperative complications in patients with nontoxic goiter. Methods: A observational study was carried out at a tertiary care academic hospital. Patients with a clinically diagnosed nontoxic goiter with normal T3, T4 and TSH values were included in the study. The study subjects underwent relevant investigations and surgical intervention. The outcome factors were histopathology of the surgically removed gland and postoperative complications. Results: A total of 67 patients of nontoxic goiter were enrolled. The mean age of the patients was 33.3±11.1 years with female preponderance. The mean duration of the thyroid swelling was 2+/-2 years. Hemithyroidectomy was most common surgery (68.7%) carried out. A majority (88%) of resected thyroid specimens were benign histopathologically as colloid goiter. An intergroup analysis was carried out between metabolic, autoimmune and neoplastic etiologies. Neoplastic etiology was significantly associated with smooth surface and hard consistency of the gland. Autoimmune goiter had significantly less than 12 months duration and painful. The postoperative complications observed were hypothyroidism (22.4%), hypoparathyroidism (10.5%), RLN palsy (6%) and SSI (3%). Conclusions: Benign pathology was commonly seen with nontoxic goiter. Hypothyroidism and Hypoparathyroidism were the most frequent postoperative complications.

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Section: Discussionsupporting

confidence: 89%

Nontoxic goiter: causes, clinical evaluation and management

2018

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“…Surgery is the preferred procedure for head and neck surgeons. Total thyroidectomy has been regarded as a safe and effective operative option for selected patients 2 , 3 .…”

Section: Introductionmentioning

confidence: 99%

Risk factors for postoperative haemorrhage after total thyroidectomy: clinical results based on 2,678 patients

Zhang

Fang

2017

Sci Rep

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The aim of this study was to analyse postoperative haemorrhage (POH) after a total thyroidectomy and explore the possible risk factors. Records of patients receiving a total thyroidectomy were reviewed and analysed for risk factors of POH. From the 2,678 patients in this study, a total of 39 patients had POH, representing an incidence of 1.5%. The majority (59.0%) of POH events occurred within four hours after surgery. Arterial haemorrhage was the primary cause of POH and was identifiable prior to venous bleeding, making it the first sign of POH. A univariate analysis revealed an association between POH, certain disease factors and BMI, but only a BMI greater than 30 was found to significantly increase the risk of POH (almost 6-fold). At the first sign of POH, all patients showed an obvious red drainage, and 92.3% of the patients had neck swelling. In summary, arterial bleeding is the main cause and first sign of postoperative haemorrhage, as it starts earlier than venous bleeding. A BMI greater than 30 significantly increases the risk of neck haematoma.

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“…This may be evident in nearly one third of subtotal thyroidectomized cases (39). On the contrary, based on results of two prospective trials, incidental cancers may be rare and no carcinoma may be discovered at all (12,47).…”

Section: Is Subtotal Thyroidectomy An Option?mentioning

confidence: 99%

“…Although being the first meta-analysis of randomized clinical trials comparing the results of total thyroidectomy and bilateral subtotal thyroidectomy, selection bias and having no standard definition of recurrence were the pitfalls of this review (39). In a recently published systematic review, although reporting an increased rate of transient hypocalcemia, total thyroidectomy was reported to be superior to subtotal thyroidectomy due to the increased risk of recurrence of disease and risk of leaving few traces of inadequately treated thyroid cancers after subtotal thyroidectomy (40).…”

Section: Is Subtotal Thyroidectomy An Option?mentioning

confidence: 99%

“…This has been recommended in the metaanalysis of Li and colleagues (39). A one-side surgery will avoid the need for a life-long L-thyroxine treatment, and in case of a recurrence, the patient will not suffer from increased complication rates due to re-do surgery of the opposite lobe, since this contralateral lobe has been left untouched during the primary surgery.…”

Section: Unilateral Thyroid Lobectomy: When?mentioning

confidence: 99%

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