World Journal of Surgery

, Volume 32, Issue 7, pp 1301–1312 | Cite as

Treatment and Prevention of Recurrence of Multinodular Goiter: An Evidence-based Review of the Literature

  • Jacob Moalem
  • Insoo Suh
  • Quan-Yang DuhEmail author



Reportedly, 10−15% of patients with goiters ultimately require operative intervention, and recurrences of multinodular goiter (MNG) account for up to 12% of all thyroid operations.


We performed an evidence-based review of articles published in the English language between January 1987 and October 2007 relevant to the subject.


Medical treatment with T4 appears to be associated with a greater proportion of patients whose nodules decreased in size by more than 50% (22% vs. 10%; range = 14–39% vs. 0–20%). Recurrence rates of benign nodular goiter after total thyroidectomy were essentially nonexistent (range = 0–0.3%) compared with those after subtotal thyroidectomy (range = 2.5–42%) and more limited resections (range = 8–34%). There was no difference between total and less-than-total thyroidectomy with respect to temporary recurrent laryngeal nerve (RLN) injury (1–10% vs. 0.9–6%, respectively) or permanent RLN palsy (0–1.4%). There was, however, a significantly higher rate of transient hypocalcemia after total thyroidectomy than less extensive operations (9–35% vs. 0–18%, respectively). In relation to redo surgery, permanent hypoparathyroidism appeared to be far more common in the redo group (0–22% vs. 0–4%) Moreover; the redo group had more frequent RLN injury, both temporary (0–22% vs. 0.5–18%) and permanent (0–13% vs. 0–4%). About half the studies examined conclude that postoperative TSH suppression is effective in reducing recurrences, while the other half state that it is not.


The definitive management and prevention of recurrence of benign nodular goiter is primarily surgical. Total thyroidectomy essentially eliminates the risk of recurrence without an accompanying increased risk of permanent hypoparathyroidism or RLN injury. Therefore, total thyroidectomy should be considered the procedure of choice for benign multinodular goiter whenever possible, especially considering that reoperations for goiter are significantly more morbid than any initial operation.


Goiter Recurrent Laryngeal Nerve Total Thyroidectomy Hospital Volume Multinodular Goiter 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  1. 1.Endocrine SurgeryUniversity of CaliforniaSan FranciscoUSA
  2. 2.Surgical ServiceVeteran Affairs Medical CenterSan FranciscoUSA

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