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Is Total Thyroidectomy the Surgical Procedure of Choice for Benign Multinodular Goiter? An Evidence-Based Review

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Abstract

Background

Benign multinodular goiter is one of the most common endocrine surgical problems. The appropriate surgical procedure for its effective and safe management is a matter of debate. Though seen by some as an overly hazardous procedure because of the risk of recurrent laryngeal nerve injury and damage to parathyroid function, total thyroidectomy has replaced subtotal thyroidectomy as the procedure of choice, as the latter is associated with significant recurrences.

Methods

A systemic literature review was undertaken of all available medical literature to evaluate whether total thyroidectomy is the appropriate, safe and effective surgical procedure for benign multinodular goiter.

Results

There is consistent level II–IV evidence that subtotal thyroidectomy results in recurrence in up to 50% patients. Incidental thyroid cancers are detected in 3%–16.6% of apparently benign goiters in numerous studies, mostly providing level IV evidence, one third of which would need further surgical treatment after subtotal thyroidectomy. Studies comparing subtotal thyroidectomy and total thyroidectomy, including two each of prospective randomized and prospective nonrandomized ones, provide level II–IV evidence that permanent complication rates associated with subtotal thyroidectomy and total thyroidectomy are not different, although the rate of transient hypocalcemia is higher with total thyroidectomy. On basis of these findings, a grade B recommendation can be made that subtotal thyroidectomy is associated with significant recurrence of goiter, leaves a small number of incidentally detected thyroid cancers inadequately treated, and provides little significant safety advantage over total thyroidectomy. Grade C recommendations can also be made about total thyroidectomy being a safe and effective procedure for benign multinodular goiters in the hands of expert surgeons, based on the extensive level IV evidence, and limited level II and level III evidence, which show that the risk of permanent vocal cord palsy and hypoparathyroidism associated with total thyroidectomy is below the acceptable 2% rate, but not without exceptions.

Conclusion

Total thyroidectomy is the procedure of choice for the surgical management of benign multinodular goiter.

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References

  1. Delbridge L (2003) Total thyroidectomy: the evolution of surgical technique. Aust N Z J Surg 73:761–768

    Article  Google Scholar 

  2. Ríos A, Rodríguez JM, Galindo PJ et al (2005) Surgical treatment of multinodular goiter in young patients. Endocrine 27:245–252

    Article  PubMed  Google Scholar 

  3. Wheeler MH (1998) Total thyroidectomy for benign thyroid disease. Lancet 23;351:1526–1527

    Article  Google Scholar 

  4. Thomusch O, Machens A, Sekulla C et al (2000) Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg 24:1335–1341

    Article  PubMed  CAS  Google Scholar 

  5. Jacobs JK, Aland JW Jr, Ballinger JF (1983) Total thyroidectomy. A review of 213 patients. Ann Surg 197:542–549

    Article  PubMed  CAS  Google Scholar 

  6. Reeve TS, Delbridge L, Cohen A et al (1987) Total thyroidectomy. The preferred option for multinodular goiter. Ann Surg 206:782–786

    Article  PubMed  CAS  Google Scholar 

  7. Heinrich S, Schäfer M, Rousson V et al (2006) Evidence-based treatment of acute pancreatitis: a look at established paradigms. Ann Surg 243:154–168

    Article  PubMed  Google Scholar 

  8. Sackett DL (1989) Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 95(2 Suppl):2S–4S

    Article  PubMed  CAS  Google Scholar 

  9. Uccheddu A, Cois A, Licheri S (1996) The choice of the intervention in the surgical treatment of nontoxic diffuse multinodular goiter. Minerva Chir 51:25–32

    PubMed  CAS  Google Scholar 

  10. Pappalardo G, Guadalaxara A, Frattaroli FM et al (1998) Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports. Eur J Surg 164:501–506

    Article  PubMed  CAS  Google Scholar 

  11. Marchesi M, Biffoni M, Tartaglia F et al (1998) Total versus subtotal thyroidectomy in the management of multinodular goiter. Int Surg 83:202–204

    PubMed  CAS  Google Scholar 

  12. Delbridge L, Guinea AI, Reeve TS (1999) Total thyroidectomy for bilateral benign multinodular goiter: effect of changing practice. Arch Surg 134:1389–1393

    Article  PubMed  CAS  Google Scholar 

  13. Cohen-Kerem R, Schachter P, Sheinfeld M et al (2000) Multinodular goiter: the surgical procedure of choice. Otolaryngol Head Neck Surg 122:848–850

    Article  PubMed  CAS  Google Scholar 

  14. Zaraca F, Di Paola M, Gossetti F et al (2000) Benign thyroid disease: 20-year experience in surgical therapy. Chir Ital 52:41–47

    PubMed  CAS  Google Scholar 

  15. Scerrino G, Salamone G, Farulla MA et al (2001) Non-toxic multinodular goitre: which surgery? Ann Ital Chir 72:647–51. Discussion 652

    PubMed  CAS  Google Scholar 

  16. Bellantone R, Lombardi CP, Boscherini M et al (2004) Predictive factors for recurrence after thyroid lobectomy for unilateral non-toxic goiter in an endemic area: results of a multivariate analysis. Surgery 136:1247–1251

    Article  PubMed  Google Scholar 

  17. Ozbas S, Kocak S, Aydintug S et al (2005) Comparison of the complications of subtotal, near total and total thyroidectomy in the surgical management of multinodular goitre. Endocr J 52:199–205

    Article  PubMed  Google Scholar 

  18. Olson SE, Starling J, Chen H (2007) Symptomatic benign multinodular goiter: unilateral or bilateral thyroidectomy? Surgery 142:458–461. Discussion 461–462

    Article  PubMed  Google Scholar 

  19. La Gamma A, Letoquart JP, Kunin N et al (1993) Nodular goiter. Retrospective analysis of 608 cases. J Chir (Paris) 130:391–396

    CAS  Google Scholar 

  20. Hisham AN, Azlina AF, Aina EN et al (2001) Total thyroidectomy: the procedure of choice for multinodular goiter. Eur J Surg 167:403–405

    Article  PubMed  CAS  Google Scholar 

  21. Mishra A, Agarwal A, Agarwal G et al (2001) Total thyroidectomy for benign thyroid disorders in an endemic region. World J Surg 25:307–310

    Article  PubMed  CAS  Google Scholar 

  22. Prades JM, Dumollard JM, Timoshenko A et al (2002) Multinodular goiter: surgical management and histopathological findings. Eur Arch Otorhinolaryngol 259:217–221

    PubMed  Google Scholar 

  23. Friguglietti CU, Lin CS, Kulcsar MA (2003) Total thyroidectomy for benign thyroid disease. Laryngoscope 113:1820–1826

    Article  PubMed  Google Scholar 

  24. Bron LP, O’Brien CJ (2004) Total thyroidectomy for clinically benign disease of the thyroid gland. Br J Surg 91:569–574

    Article  PubMed  CAS  Google Scholar 

  25. Colak T, Akca T, Kanik A et al (2004) Total versus subtotal thyroidectomy for the management of benign multinodular goiter in an endemic region. Aust N Z J Surg 74:974–978

    Article  Google Scholar 

  26. Giles Y, Boztepe H, Terzioglu T et al (2004) The advantage of total thyroidectomy to avoid reoperation for incidental thyroid cancer in multinodular goiter. Arch Surg 139:179–182

    Article  PubMed  Google Scholar 

  27. Alimoglu O, Akdag M, Sahin M et al (2005) Comparison of surgical techniques for treatment of benign toxic multinodular goiter. World J Surg 29:921–924

    Article  PubMed  Google Scholar 

  28. Ríos A, Rodríguez JM, Canteras M et al (2005) Surgical management of multinodular goiter with compression symptoms. Arch Surg 140:49–53

    Article  PubMed  Google Scholar 

  29. Erbil Y, Barbaros U, Salmaslioglu A et al (2006) The advantage of near-total thyroidectomy to avoid postoperative hypoparathyroidism in benign multinodular goiter. Langenbecks Arch Surg 391:567–573

    Article  PubMed  Google Scholar 

  30. Gomez Palacios A, Gutierrez MT, Gomez J et al (2006) Development and outcomes of the surgical management of multinodular goiter. Cir Esp 80:83–89

    PubMed  Google Scholar 

  31. Miccoli P, Minuto MN, Galleri D et al (2006) Incidental thyroid carcinoma in a large series of consecutive patients operated on for benign thyroid disease. Aust N Z J Surg 76:123–126

    Article  Google Scholar 

  32. Reeve TS, Curtin A, Fingleton L (1994) Can total thyroidectomy be performed as safely by general surgeons in provincial centers as by surgeons in specialized endocrine surgical units? Making the case for surgical training. Arch Surg 129:834–836

    PubMed  CAS  Google Scholar 

  33. De Toma G, Tedesco M, Gabriele R (1995) Total thyroidectomy in the treatment of multinodular toxic goiter. G Chir 16:373–376

    PubMed  Google Scholar 

  34. Gardiner KR, Russell CF (1995) Thyroidectomy for large multinodular colloid goitre. J R Coll Surg Edinb 40:367–370

    PubMed  CAS  Google Scholar 

  35. Liu Q, Djuricin G, Prinz RA (1998) Total thyroidectomy for benign thyroid disease. Surgery 123:2–7

    PubMed  CAS  Google Scholar 

  36. Müller PE, Kabus S, Robens E (2001) Indications, risks, and acceptance of total thyroidectomy for multinodular benign goiter. Surg Today 31:958–962

    Article  PubMed  Google Scholar 

  37. Bellantone R, Lombardi CP, Bossola M (2002) Total thyroidectomy for management of benign thyroid disease: review of 526 cases. World J Surg 26:1468–1471

    Article  PubMed  Google Scholar 

  38. Koyuncu A, Dökmetas HS, Turan M et al (2003) Comparison of different thyroidectomy techniques for benign thyroid disease. Endocr J 50:723–727

    Article  PubMed  Google Scholar 

  39. Thomusch O, Sekulla C, Dralle H (2003) Is primary total thyroidectomy justified in benign multinodular goiter? Results of a prospective quality assurance study of 45 hospitals offering different levels of care. Chirurg 74:437–443 [in German]

    Article  PubMed  CAS  Google Scholar 

  40. Acun Z, Comert M, Cihan A et al (2004) Near-total thyroidectomy could be the best treatment for thyroid disease in endemic regions. Arch Surg 139:444–447. Discussion 447

    Article  PubMed  Google Scholar 

  41. Zambudio AR, Rodríguez J, Riquelme J et al (2004) Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery. Ann Surg 240:18–25

    Article  PubMed  Google Scholar 

  42. Lang BH, Lo CY (2005) Total thyroidectomy for multinodular goiter in the elderly. Am J Surg 190:418–423

    Article  PubMed  Google Scholar 

  43. Chiang F-Y, Lin J-C, Wu C-W et al (2006) Morbidity after total thyroidectomy for benign thyroid disease: comparison of Graves’ disease and non-Graves’ disease. Kaohsiung J Med Sci 22:554–559

    Article  PubMed  Google Scholar 

  44. Serpell JW, Phan D (2007) Safety of total thyroidectomy. Aust N Z J Surg 77:15–19

    Article  Google Scholar 

  45. Mishra A, Agarwal G, Agarwal A et al (1999) Safety and efficacy of total thyroidectomy in hands of endocrine surgery trainees. Am J Surg 178:377–380

    Article  PubMed  CAS  Google Scholar 

  46. Acun Z, Cihan A, Ulukent SC et al (2004) A randomized prospective study of complications between general surgery residents and attending surgeons in near-total thyroidectomies. Surg Today 34:997–1001

    Article  PubMed  Google Scholar 

  47. Snook KL, Stalberg PL, Sidhu SB et al (2007) Recurrence after total thyroidectomy for benign multinodular goiter. World J Surg 31:593–598; discussion 599–600

    Article  PubMed  Google Scholar 

  48. Sandonato L, Graceffa G, Cipolla C et al (2003) Benign diseases of the thyroid: indications for surgical treatment and the current role of total thyroidectomy. Chir Ital 55:179–187

    PubMed  Google Scholar 

  49. Soh EY, Clark OH (1996) Surgical considerations and approach to thyroid cancer. Endocrinol Metab Clin North Am 25:115–139

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Endocrine & Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, India

    Gaurav Agarwal & Vivek Aggarwal

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  1. Gaurav Agarwal
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  2. Vivek Aggarwal
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Correspondence to Gaurav Agarwal.

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Agarwal, G., Aggarwal, V. Is Total Thyroidectomy the Surgical Procedure of Choice for Benign Multinodular Goiter? An Evidence-Based Review. World J Surg 32, 1313–1324 (2008). https://doi.org/10.1007/s00268-008-9579-8

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