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Subtotal and Near Total Versus Total Thyroidectomy for the Management of Multinodular Goiter

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Abstract

Background

The purpose of the present work was to compare rates of postsurgical complications following thyroidectomy for multinodular goiter through a retrospective multicenter cohort study.

Methods

All cases of thyroidectomy (total—TT; near total—NT; and bilateral subtotal—ST) performed in two hospitals from 1990 to 2005 were studied to determine the incidence of complications after each procedure. Follow-up checked injury of laryngeal nerves, hypoparathyroidism, hypothyroidism, pathology recurrence, and appearance of neoplasm.

Results

There were 6,223 cases: TT, n = 3,834 (61.6%); ST, n = 2,238 (36%); and NT, n = 151 (2.4%) NT). Of this total, 2,758 (44.3%) patients were men and 3,465 (55.7%) were women with a mean age of 48.7. Postoperative mean follow-up was 7 years, 2 months. Permanent recurrent laryngeal nerve (RLN) injury was observed in 1.4% in the TT group, 1.2% in the ST group, and 1.1% in the NT group (p > 0.1). Permanent hypocalcemia was observed in 2% in TT group, 1.9% in the ST group, and 2% in the NT group (p > 0.1). Permanent hypothyroidism occurred in all patients in the TT and NT groups, compared to 91% of the patients in the ST group (p > 0.1). Recurrence of benign disease was noted in 491 patients (20.5% of ST and NT cases combined; p < 0.05), n = 482 (21.5%) after ST and n = 9 (5.9%) after NT. Of the patients with recurrence, 173 needed a completion thyroidectomy. Malignant transformation was observed in 28 cases.

Conclusions

There is no statistically significant difference in complications among TT, NT, and ST groups. Partial thyroidectomies provide no decisive advantage over total thyroidectomies in terms of subsequent requirements of supplemental hormone therapy. The rate of reoperation in cases of recurrent pathology and incidental carcinoma was high.

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Author notes

  1. Michael Vaiman

    Present address: , 33 Shapira Street, Bat Yam, 59561, Israel

Authors and Affiliations

  1. Department of Otorhinolaryngology Head and Neck Surgery, Assaf HaRofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel

    Michael Vaiman, Julian Olevson & Nathan Shlamkovich

  2. Department of Otorhinolaryngology Head and Neck Surgery, Ivanovo State Medical Academy, Ivanovo, Russia

    Andrey Nagibin & Alexey Buyankin

  3. Department of Endocrinology, Assaf HaRofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Philippe Hagag

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  1. Michael Vaiman
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Correspondence to Michael Vaiman.

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Vaiman, M., Nagibin, A., Hagag, P. et al. Subtotal and Near Total Versus Total Thyroidectomy for the Management of Multinodular Goiter. World J Surg 32, 1546–1551 (2008). https://doi.org/10.1007/s00268-008-9541-9

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