Unilateral Thyroidectomy for the Treatment of Benign Multinodular Goiter

Abstract

BACKGROUND-Benign multinodular goiter (MNG) is one of the most commonly treated thyroid disorders. While bilateral resection is the accepted surgical treatment for bilateral MNG, the appropriate surgical resection for unilateral MNG continues to be debated. Bilateral resection generally has lower recurrence rates but higher complication rates than unilateral resection. Therefore, the purpose of this study was to define the recurrence and complication rates of unilateral and bilateral resections in order to determine the appropriate intervention for patients with unilateral, benign MNG.

Nodular recurrence and hypothyroidism following partial thyroidectomy for benign nodular thyroid disease in children and adolescents

“…We observed high levels of heterogeneity between studies that explains this variability and makes comparison difficult. Some reports only focused on solitary nodules [5,12], some on unilateral multi nodular goiters (MNG) [4,13], others, like ours, on both pathologies [11,14]. Depending on the study, the rate of patients who had post-operative ultrasound was different: 100% for Bellantone et al [14] which is equivalent to what is reported in our present study, 30% for Bourguignat et al [15], 21% for Niepomniszcze et al [12].…”

“…However, several authors propose to achieve a LI if MNG is limited to one thyroid lobe [4,11,40], including in children [2]. Arguments in favour of TT are a lower nodular recurrence rate [22,40], a rate of permanent surgical complications (recurrent laryngeal nerve paralysis, hypoparathyroidism) not higher if in experienced hands [4,22], and surgical difficulties increased if LI was performed first with need for further completion thyroidectomy [22].…”

“…However, several authors propose to achieve a LI if MNG is limited to one thyroid lobe [4,11,40], including in children [2]. Arguments in favour of TT are a lower nodular recurrence rate [22,40], a rate of permanent surgical complications (recurrent laryngeal nerve paralysis, hypoparathyroidism) not higher if in experienced hands [4,22], and surgical difficulties increased if LI was performed first with need for further completion thyroidectomy [22]. Arguments in favour of LI are a lower rate of transitory surgical complications (recurrent laryngeal nerve paralysis, hypocalcaemia, hematoma) [4,22,40], a low rate of completion thyroidectomy [11], and requirement for a life hormone replacement therapy if TT.…”

“…The latter is at the forefront in children and adolescents according to malignancy rates described in the literature as higher than in adults [2]. In case of unilateral disease and benign histology, several reports suggest partial thyroidectomy, in both adults and children [3,4]: lobectomy-isthmusectomy (LI) or nodule resection (NR) when a single nodule is easily accessible.…”

Etiopathology, clinical features, and treatment of diffuse and multinodular nontoxic goiters

“…Both total and subtotal techniques have similar rates of permanent complications such as hypoparathyroidism and vocal palsy, but total thyroidectomy is preferred since the risk of these complications increases with reintervention [69]. In patients with unilateral NNG, some authors recommend unilateral thyroidectomy based on a low rate of recurrence (2 %) and high rate of maintenance of euthyroidism (73 %) [70]. Postsurgical recurrence rates are directly proportional to the volume of the remaining thyroid tissue.…”