Multinodular Goitre Presenting as a Clinical Single Nodule: How Effective Is Hemithyroidectomy?

Wadström, C; Zedenius, Jan; Guinea, Ana I.; Reeve, T. S.; Delbridge, Leigh

doi:10.1046/j.1440-1622.1999.01485.x

Cited by 43 publications

(29 citation statements)

References 23 publications

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“…In order to improve the outcome of these patients, most surgeons have been looking for a treatment that results in the lowest recurrence and complication rate (Acun et al, 2004). Subtotal thyroidectomy because of its low incidence of postoperative complications, has previously been advocated by some for the treatment of benign thyroid disease, but recurrence rates as high as 45% have been reported (Waldstrom et al, 1998;Acun et al, 2004;Salman & Omer, 2007).…”

Section: Introductionmentioning

confidence: 99%

Patterns and outcome of surgical management of goitres at Bugando Medical Centre in northwestern Tanzania

Chalya¹,

Rambau²,

Mabula

et al. 2011

Tanzania J Hlth Res

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Despite the well established endemicity of goitres little work has been done on the management of goiters in Tanzania. A cross-sectional study was conducted at Bugando Medical Centre (BMC) in Mwanza, Tanzania to determine the pattern and outcome of surgical management of goitres. Data was collected using a pre-tested, coded questionnaire. A total of 152 patients were studied of which 140 (92.1%) were females and males were 12 (7.9%) (F: M = 11.7: 1). Their ages ranged from 18 to 72 years (mean =38.4 12.5 years). The mean duration of illness was 9.2 years. The thyroid gland size at admission was grade III in 63.8% of patients. Multinodular goitres were reported in 51.3% of patients. The majority of patients (92.1%) presented with euthyroid goitres and the remaining (7.9%) patients had toxic goitres. Pressure symptoms and cosmetic disfigurement were the common indications for thyroidectomy in 47.4% and 23.7%, respectively. Near total thyroidectomy and total thyroidectomy were the surgical procedures performed for benign and malignant goitres in 47.3% and 8.1% of patients, respectively. Simple multinodular goitres were the most common histopathological pattern accounting for 67.2% of cases. Twelve (7.9%) patients had a histologically proven thyroid malignancy, of which follicular and papillary carcinoma were reported in 41.7% and 33.3% of cases, respectively. Post-operative complications rate was 7.9%. The mean length of hospital stay was 14.4 days (range 3 to 34 days). Five patients died giving a mortality rate of 3.4%. In conclusion, this study has shown that the pattern of surgical goitres seen at Bugando Medical Centre is similar to what is reported from other parts of the world. However, the majority of patients present for surgery very late with huge goitres predisposing them to increased risk of post-operative complications, prolonged length of hospital stay and cost of medical care. It is therefore recommended that health education should be given to the community about the cause, prevention and treatment options so that patients could seek early medical attention. __________________________________________________________________________________________

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Section: Introductionmentioning

confidence: 99%

Patterns and outcome of surgical management of goitres at Bugando Medical Centre in northwestern Tanzania

Chalya¹,

Rambau²,

Mabula

et al. 2011

Tanzania J Hlth Res

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“…When one of the lobes is morphologically normal in non-toxic goiter, total thyroidectomy is not recommended although in the longer term follow-up approximately 12% of these patients develop reccurence and half of them require the second operation (32).…”

Section: Discussionmentioning

confidence: 99%

Total Thyroidectomy for Nodular, Benign Thyroid Diseases in Terms of Larynx Function Examinations - Is it a New Treatment Standard?

Kaczka

Jankowski

Kopczyński

et al. 2010

Polish Journal of Surgery

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Aim of the study was the assessment of total thyroidectomy (TT) value as a treatment method of goiter with particular emphasis on the results of laryngological examination. material and methods. From 15 th April 2008 to 1 st July 2009 there were 125 (72.7%) TTs, 12 (7%) TTs and appropriate lymphadenectomies, 9 (5.2%) near TTs, 14 (8.1%) lobectomies, 5 (2.9%) completion thyroidectomies and 6 (3.4%) other operations. Vocal cords function was assessed routinely one day before, two days after operation by an otolaryngologist. Voice quality was assessed by patients in VHI questionnaire theirselves. Results. Five patients had one-sided vocal cord paralysis before the operation. The one-sided transient recurrent laryngeal nerve injuries was observed in 16 other patients (9.3% among patients and 4.6% among nerves at risk)in the second day after the operation. There was no bilateral recurrent laryngeal nerve injury. From three to six months after the operation, 21 (among 23) patients with vocal cord movement disability were examined once again by the same otolaryngologist. The same vocal cord paralysis was observed in 4 sicks (one person died), which was found preoperatively. Seven (4%) other patients had permanent one vocal cord paresis. This represents 2% the nerves at risk. Three of them were recognized benign lesions and four thyroid cancer. Our percentage of early, postoperative hypoparathyroidism was 6.4% and persistent was 1.7%. VHI score in the group with paresis or paralysis of vocal cord gave the score of 4 to 90 points-an average of 49 points. In patients with proper vocal cord movement there were results from 0 to 6 points-an average of 2 points. conclusions. 1. Total thyroidectomy in the treatment of bilateral goiter without malignancy features is radical and safe procedure. 2. It protects against goiter relapse and its consequences. 3. Complications rates after total thyroidectomy are at acceptable and comparable proportions to the other operation types.

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“…Coexistence of multiple nodules was not considered as a risk factor in the large number of staging systems in the literature [12]. However, this issue is important because there are some controversies in the surgical management of multinodular goiter [13][14][15][16]. Moreover, some suggest that fine needle aspiration is not sensitive enough to differentiate malignant from benign multinodular goiter [17].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of well-differentiated thyroid cancer associated with multinodular goiter

Cheng

Liu

Tzen

et al. 2008

Langenbecks Arch Surg

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Multinodular Goitre Presenting as a Clinical Single Nodule: How Effective Is Hemithyroidectomy?

Cited by 43 publications

References 23 publications

Patterns and outcome of surgical management of goitres at Bugando Medical Centre in northwestern Tanzania

Patterns and outcome of surgical management of goitres at Bugando Medical Centre in northwestern Tanzania

Total Thyroidectomy for Nodular, Benign Thyroid Diseases in Terms of Larynx Function Examinations - Is it a New Treatment Standard?

Characteristics of well-differentiated thyroid cancer associated with multinodular goiter

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