The Morbidity of Reoperative Surgery for Recurrent Benign Nodular Goitre: Impact of Previous Unilateral Thyroid Lobectomy versus Subtotal Thyroidectomy

Abstract

Background. Subtotal thyroidectomy (STT) was previously considered the gold standard in the surgical management of multinodular goitre despite its propensity for recurrence. Our aim was to assess whether prior STT or unilateral lobectomy was associated with increased reoperative morbidity. Methods. A retrospective analysis was conducted extracting data from our endocrine surgical database for the period from January 1991 to June 2006. Two patient groups were defined: Group 1 consisted of patients with previous unilateral thyroid lobectomy; Group 2 had undergone previous STT. Specific outcomes investigated were transient and permanent recurrent laryngeal nerve (RLN) injury and hypoparathyroidism. Results. 494 reoperative cases were performed which consisted of 259 patients with previous unilateral lobectomy (Group 1) and 235 patients with previous subtotal thyroidectomy (Group 2). A statistically significant increase relating to previous STT was demonstrated in both permanent RLN injury (0.77% versus 3.4%, RR 4.38, P = 0.038) and permanent hypoparathyroidism (1.5% versus 5.1%, RR 3.14, P = 0.041). Transient nerve injury and hypocalcaemia incidence was comparable. Conclusions. Reoperative surgery following subtotal thyroidectomy is associated with a significantly increased risk of permanent recurrent laryngeal nerve injury and hypoparathyroidism when compared with previous unilateral thyroidectomy. Subtotal thyroidectomy should therefore no longer be recommended in the management of multinodular goitre.

Completion Thyroidectomy: Safer than Thought

“…Permanent RLN palsy and hypoparathyroidism were significantly higher in the second group (0.77%vs. 3.4% and 1.5% vs. 5.1%) [21]. …”

Recurrent laryngeal nerve injury and hypoparathyroidism rates in reoperative thyroid surgery

“…Rudolph et al (18) observed that as compared to patients who had undergone unilateral lobectomy for multinodular goiter, patients who had previously undergone subtotal thyroidectomy had a significantly higher permanent RLN injury rate (3.44% vs. 0.77%). Our results are consistent with those of Kurmann et al, whose retrospective study showed no statistical difference in permanent RLN nerve injury between patients undergoing ipsilateral and those undergoing contralateral redo-surgery (3.8% vs. 0%) (6).…”

Less than total thyroidectomy for goiter: when and how?

“…As a result, total thyroidectomy was recommended as the procedure of choice for benign multinodular goiter (2). In the retrospective study of Rudolph and colleagues, total thyroidectomy was demonstrated to be safe and efficacious, especially with the aid of technological advancements like vessel sealing systems and intraoperative nerve monitoring (9). Alongside this, concerns raise due to the thermal spread of the recent vessel sealing systems, which may harm the parathyroid tissue, as well as the recurrent laryngeal nerve.…”

“…Rudolph et al demonstrated a significantly increased risk of permanent recurrent laryngeal nerve injury and hypoparathyroidism following previous subtotal thyroidectomy when compared to previous unilateral thyroidectomy (9). Recurrence may arise from the remnant posterolateral tissue that extends into the retrotracheal and retroesophageal areas.…”

“…Most centers have adopted total and/or near total thyroidectomy ( Figure 2) and reported low morbidity rates similar to the subtotal procedure. Meanwhile, the number of publications related to postoperative parathyroid failure after total thyroidectomy has been steadily climbing in recent years and many of patients included in these cohort studies had surgery for benign goiter (1,9,10). This is the reason why it is felt the time is ripe for an in-depth review on this specific topic and various surgical methods that impact on morbidity after goiter surgery will be discussed.…”