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Bilateral Subtotal Thyroidectomy Versus Hemithyroidectomy Plus Subtotal Resection (Dunhill Procedure) for Benign Goiter: Long-Term Results of a Prospective, Randomized Study

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Abstract

Background

Two recent meta-analyses of mostly retrospective studies have shown high recurrence rates following subtotal resection of bilateral multinodular goiter. Therefore, many endocrine centers have changed their operative procedures in favor of thyroidectomy. Consequently, the rate of complications, especially hypoparathyroidism, has increased. Hemithyroidectomy plus subtotal resection (Dunhill operation) overcomes some disadvantages of bilateral subtotal resection (BST). We performed a prospective, randomized trial to compare the Dunhill operation (DO) and BST for benign goiters.

Methods

Between October 1994 and March 1997, a total of 200 consecutive patients were randomized into two study groups. Primary outcome measure was the incidence of recurrent goiter. Secondary outcome measures were incidence of recurrent nerve palsy and hypoparathyroidism. In all patients, ultrasonography of the thyroid and measurement of serum calcium and parathyroid hormone were performed. Recurrent nerve function was analyzed by indirect laryngoscopy. Long term data (>10 years after surgery) were available in 70 DO patients and 65 BST patients. Mean follow-up was 11.3 ± 4.2 years (10–12 years).

Results

No differences were seen in the operating times, transient and permanent hypoparathyroidism, or recurrent nerve palsy. In the long-term, mean thyroid volumes were significantly lower in the DO group (3.5 ± 3.5 vs. 6.4 ± 6.5 ml, p = 0.01). One reoperation was required in the BST group because of recurrence versus none in the DO group. 68 of 70 (97 %) patients in group DO and 59 of 65 (91 %) in group BST had ongoing thyroid hormone therapy with no significant differences in mean dosages of l-thyroxine.

Conclusions

The Dunhill operation and BST are safe procedures. In case of small remnants, clinically significant recurrence is a rare event especially after the Dunhill operation.

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Conflict of interest

The authors have no potential or real conflict of interests.

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Authors and Affiliations

  1. Department of General, Visceral, and Transplant Surgery, Charité Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Germany

    Nada Rayes, Andre Klötzler, Peter Neuhaus & Daniel Seehofer

  2. Department of General and Visceral Surgery, DRK Westend, Spandauer Damm 130, 14050, Berlin, Germany

    Thomas Steinmüller

  3. Department of Internal Medicine, Charité Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Germany

    Sabine Schröder

  4. Department of Nuclear Medicine, Charité Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Germany

    Helga Bertram

  5. Department of Radiology, Charité Campus Virchow, Augustenburger Platz 1, 13353, Berlin, Germany

    Timm Denecke

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  1. Nada Rayes
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  2. Thomas Steinmüller
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  3. Sabine Schröder
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  4. Andre Klötzler
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Correspondence to Nada Rayes.

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Rayes, N., Steinmüller, T., Schröder, S. et al. Bilateral Subtotal Thyroidectomy Versus Hemithyroidectomy Plus Subtotal Resection (Dunhill Procedure) for Benign Goiter: Long-Term Results of a Prospective, Randomized Study. World J Surg 37, 84–90 (2013). https://doi.org/10.1007/s00268-012-1793-8

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