Comparison of Surgical Techniques for Treatment of Benign Toxic Multinodular Goiter

Abstract

Controversy remains regarding the best surgical approach for toxic multinodular goiter (MNG). The aim of this study was to evaluate the results of various thyroid operations for managing toxic MNG. A group of 100 patients with toxic MNG were divided into three groups and managed with total thyroidectomy (TT; group I, n-17), near-total thyroidectomy (NTT; group II, n = 48), or bilateral subtotal thyroidectomy (BST; group III, n = 35). Patients were compared with regard to age, gender, surgical operations, complications, thyroid hormone status, duration of hospitalization, and the reoperation rate for incidentally found thyroid carcinomas. There were 14 men (14%) and 86 women (86%) with a mean age of 47.03 +/- 13.56 years (range 19-77 years). After the operation two patients had a hematoma, and one patient had a seroma. Four patients had unilateral vocal cord paralysis, and one had permanent paralysis. Moreover, 18 patients had transient and 2 patients permanent hypocalcemia. There was no significant difference between the groups regarding complications (p < 0.05). Permanent hypothyroidism was achieved in all patients in group I and 44 patients (92%) in group II, whereas in group III only 10 (29%) patients had hypothyroidism. Conversely, hyperthyroidism, both subclinical and clinical, was noted only in group III (12 patients, 34%) during follow-up. We think that TT and NTT are safe, effective approaches in the treatment of toxic MNG, preventing recurrence of thyrotoxicosis and reoperation for incidentally found thyroid cancers. The complication rates for TT and NTT were similar to that for BST. Hence these operation should be considered for patients referred for surgical treatment of toxic MNG.

Hypocalcemia After Thyroid Surgery Single-Center Experience Based on 987 Patients Operated on for Various Thyroid Diseases Within One Year

“…The study has demonstrated lack of significant difference in the prevalence of hypocalcemia in both groups. Similar data was reported by Alimoglu et al, Bellantone et al and Pappalardo et al (3,12,13). These authors stress the presence of complications following bilateral subtotal thyroid resections.…”

Comparison of Complications between Total and Subtotal Thyroidectomy in Simple Multinodular Goitre

“…In another series RLN palsy was reports 5.88% of TT group and 2.85% after STT group 11 . In present study RLN palsy occurred in 5.3% of TT group 2.2% of STT group.…”

Total Thyroidectomy in Multinodular Goiter: An African Experience

“…For the selected cases, the decision for total excision is sometimes taken during surgery due to the absence of macroscopically normal tissue from the thyroid gland; the patient is informed of this possibility preoperatively. Before the 20th century total thyroidectomy was an intervention reserved for cases of thyroid cancer and benign thyroid pathology for rarely because of the high rate of postoperative complications [8]. Currently it is the standard treatment for toxic or non-toxic multinodular goiter.…”

“…Permanent hypocalcemia is absent in the present study, it is most often linked to accidental parathyroid removal. The transient hypocalcemia rate is in the range of data in the literature ranging from 1.6% to 20% [8] [9] [11] [12].…”