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The Change in Surgical Practice from Subtotal to Near-Total or Total Thyroidectomy in the Treatment of Patients with Benign Multinodular Goiter

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Abstract

Background

Although total thyroidectomy is the procedure of choice in patients with thyroid carcinoma, this surgical approach has emerged as a surgical option to treat patients with benign multinodular goiter (BMNG), especially in endemically iodine-deficient regions. The aim of this study was to review our experience with patients with BMNG in an endemically iodine-deficient region treated by either subtotal or total/near-total thyroidectomy, and to document whether total or near-total thyroidectomy decreased the rate of completion thyroidectomy for incidentally diagnosed thyroid carcinoma in comparison to the patients with BMNG treated initially by subtotal thyroidectomy.

Methods

Two thousand five hundred ninety-two patients with BMNG were included. There were 1695 bilateral subtotal thyroidectomies (group 1) and 1211 total or near-total thyroidectomies (group 2) for BMNG during this period. All patients were euthyroid and had no history of hyperthyroidism, radiation exposure, or familial thyroid carcinoma. Any patient with preoperative or perioperative suspicion of malignancy or hyperthyroidism was excluded.

Results

Bilateral subtotal thyroidectomy was performed in 1695 patients (58.3%) in group 1 and total or near-total thyroidectomy in 1211 patients (41.7%), in group 2, respectively. The incidence of incidental thyroid carcinoma was found to be 7.2% (n = 210/2906). Although the rate of permanent hypoparathyroidim and transient or permanent unilateral recurrent laryngeal nerve (RLN) palsy were not significantly different between the two groups, transient hypoparathyroidism was significantly higher in group 2 than in group 1 (8.4% vs. 1.42%; p < 0.001, odds ratio [OR] = 52.98). The incidence of thyroid carcinoma was significantly higher in group 2 (10.7%, n = 129/1211) than in group 1 (4.68%, n = 81/1695) (p < 0.001; OR = 39.1).Thirty-eight patients in group 1 (2.24%) underwent completion thyroidectomy, whereas completion thyroidectomy has been not indicated in group 2 (p = 0.007). Two of 38 patients (5.26%) had thyroid papillary microcarcinoma on their remnant thyroid tissue. The rate of recurrent goiter was 7.1% in group 1. The average time to recurrence in group 1 was 14.9 ± 8.7 years. Six of 121 patients with recurrent disease (4.95%) has been operated on.

Conclusions

Subtotal thyroidectomy resulted in a significantly higher rate of completion thyroidectomy for incidentally diagnosed thyroid carcinoma compared with total or near-total thyroidectomy in patients with BMNG. The extent of surgical resection had no significant effect on the rate of permanent complications. We recommend total or near-total thyroidectomy in BMNG to prevent recurrence and to eliminate the necessity for early completion thyroidectomy in case of a final diagnosis of thyroid carcinoma.

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References

  1. Siragusa G, Lanzara P, Di Pace G (1998) Subtotal thyroidectomy or total thyroidectomy in the treatment of benign thyroid disease: our experience [in Italian]. Minerva Chir 53:233–238

    PubMed  CAS  Google Scholar 

  2. Reeve TS, Delbribge L, Cohen A, Crummer P (1987) Total thyroidectomy: the preferred option for multinodular goiter. Ann Surg 206:782–786

    Article  PubMed  CAS  Google Scholar 

  3. 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 

  4. 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 

  5. Pappalardo G, Guadalaxara A, Frattaroli FM, Illomei G, Falaschi P (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 

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

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  8. Gough IR, Wilkinson D (2000) Total thyroidectomy for management of thyroid disease. World J Surg 24:962–965

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  10. Reeve TS, Delbridge L, Brady, Crummer P, Smyth C (1988) Secondary thyroidectomy: a twenty-year experience. World J Surg 12:449–453

    Article  PubMed  CAS  Google Scholar 

  11. Pezzullo L, Delrio P, Losito NS, Caraco C, Mozzillo N (1997) Post-operative complications after completion thyroidectomy for differentiated thyroid cancer. Eur J Surg Oncol 23:215–218

    Article  PubMed  CAS  Google Scholar 

  12. Bergamaschi R, Becouarn G, Ronceray J, Arnaud JP (1998) Morbidity of thyroid surgery. Am J Surg 176:71–75

    Article  PubMed  CAS  Google Scholar 

  13. Wilson DB, Staren ED, Prinz RA (1998) Thyroid reoperations: indications and risks. Am Surg 64:674–678

    PubMed  CAS  Google Scholar 

  14. Beahrs OH, Vandertoll DJ (1963) Complications of secondary thyroidectomy. Surg Gynecol Obstet 117:535–539

    PubMed  CAS  Google Scholar 

  15. McCall A, Jarosz H, Lawrence AM, Paloyan E (1986) The incidence of thyroid carcinoma in solitary cold nodules and in multinodular goiters. Surgery 100:1128–1132

    PubMed  CAS  Google Scholar 

  16. Koh KBH, Chang KW (1992) Carcinoma in multinodular goitre. Br J Surg 79:266–267

    Article  PubMed  CAS  Google Scholar 

  17. Chao TC, Jeng LB, Lin JD, Chen MF (1997) Reoperative thyroid surgery. World J Surg 21:644–647

    Article  PubMed  CAS  Google Scholar 

  18. Gould EA, Hirsch E, Brecher I (1965) Complications arising in the course of thyroidectomy. Arch Surg 90:81–85

    PubMed  CAS  Google Scholar 

  19. Foster RS Jr (1978) Morbidity and mortality after thyroidectomy. Surg Gynecol Obstet 146:423–429

    PubMed  Google Scholar 

  20. 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 

  21. Giles Y, Boztepe H, Terzioglu T, Tezelman S (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 

  22. Calabro S, Auguste LJ, Attie JN (1988) Morbidity of completion thyroidectomy for initially misdiagnosed thyroid carcinoma. Head Neck Surg 10:235–238

    PubMed  CAS  Google Scholar 

  23. Menegaux F, Turpin G, Dahman M, Leenhardt L, et al (1999) Secondary thyroidectomy in patients with prior thyroid surgery for benign disease: a study of 203 patients. Surgery 125:479–483

    Google Scholar 

  24. Anderson PE, Hurley PR, Rosswick P (1990) Conservative treatment and long term prophylactic thyroxine in the prevention of recurrence of multinodular goiter. Surg Gynecol Obstet 171:309–314

    PubMed  CAS  Google Scholar 

  25. Kraimps JL, Marechaud R, Gineste D et al (1993) Analysis and prevention of recurrent goiter. Surg Gynecol Obstet 176:319–322

    PubMed  CAS  Google Scholar 

  26. Piraneo S, Vitri P, Galimberti A, Salvaggio A, Bastagli A (1997) Ultrasonographic surveillance after surgery for euthyroid goitre in patients treated or not with thyroxine. Eur J Surg 163:21–26

    PubMed  CAS  Google Scholar 

  27. Rojdmark J, Jarhult J (1995) High long term recurrence rate after subtotal thyroidectomy for nodular goitre. Eur J Surg 161:725–727

    PubMed  CAS  Google Scholar 

  28. Maxon HR, Englaro RE, Thomas SR et al (1992) Radioiodine-131 therapy for well-differentiated thyroid cancer—a quantitative radiation dosimetric approach: outcome and validation. J Nucl Med 33:1132–1136

    PubMed  Google Scholar 

  29. Hay ID, Bergstralh EJ, Goellner JR, Ebersold, Grant CS (1993) Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery 114:1050–1058

    PubMed  CAS  Google Scholar 

  30. Mazzaferri EL (1987) Papillary thyroid carcinoma: factors influencing prognosis and current therapy. Semin Oncol 14:315–322; erratum in Semin Oncol 1988; 15(3):x

    Google Scholar 

  31. Shah JP, Loree TR, Dharker D, Strong EW, Begg C, Vlamis V (1992) Prognostic factors in differentiated carcinoma of the thyroid gland. Am J Surg 164:658–661

    Article  PubMed  CAS  Google Scholar 

  32. Baudin E, Travagli JP, Ropers J et al (1998) Microcarcinoma of the thyroid gland: the Gustave-Roussy Institute experience. Cancer 83:553–559

    Article  PubMed  CAS  Google Scholar 

  33. Samaan NA, Schultz PN, Hickey RC et al (1992) The results of various modalities of treatment of well differentiated thyroid carcinoma: a retrospective review of 1599 patients. J Clin Endocrinol Metab 75:714–720

    Article  PubMed  CAS  Google Scholar 

  34. Logue JP, Tsang RW, Brierley JD, Simpson WJ (1994) Radioiodine ablation of residual tissue in thyroid cancer: relationship between administered activity, neck uptake and outcome. Br J Radiol 67:1127–1131

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Cerrahi Monoblok, Capa-Topkapı, 34390, Istanbul, Turkey

    Serdar Tezelman, Ismail Borucu, Yasemin Senyurek (Giles), Fatih Tunca & Tarik Terzioglu

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  1. Serdar Tezelman
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  2. Ismail Borucu
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  3. Yasemin Senyurek (Giles)
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  4. Fatih Tunca
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  5. Tarik Terzioglu
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Correspondence to Serdar Tezelman.

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Tezelman, S., Borucu, I., Senyurek (Giles), Y. et al. The Change in Surgical Practice from Subtotal to Near-Total or Total Thyroidectomy in the Treatment of Patients with Benign Multinodular Goiter. World J Surg 33, 400–405 (2009). https://doi.org/10.1007/s00268-008-9808-1

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