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[Total versus subtotal thyroidectomy for multiple node goiter: experience with 350 surgically treated cases].

S Ciuni1, F Catalano, D Fimognari

  • 1Dipartimento di Chirurgia, Università degli Studi di Catania.

Il Giornale Di Chirurgia
|September 29, 2000
PubMed
Summary

Surgical treatment for multinodular goiter is debated. Total thyroidectomy is often necessary as microscopic disease is common, even in seemingly healthy thyroid tissue, to prevent recurrence.

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Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Pathology

Background:

  • Surgical management of benign thyroid conditions, particularly multinodular goiter, remains a subject of debate.
  • Treatment options range from conservative approaches like lobectomy or subtotal thyroidectomy to total thyroidectomy.

Purpose of the Study:

  • To evaluate the extent of microscopic disease in multinodular goiter.
  • To inform surgical decision-making for benign thyroid pathology.

Main Methods:

  • Retrospective analysis of 534 patients with benign thyroid pathology from January 1985 to July 1999.
  • Surgical interventions included total thyroidectomy (275 patients) and lobectomy/subtotal thyroidectomy (75 patients).
  • Histopathological examination of resected thyroid tissue.

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Main Results:

  • Of 330 primitive goiter cases, 13 (3.9%) had incidental microscopic carcinoma.
  • Microscopic examination revealed widespread disease, including chronic lymphocytic thyroiditis, follicular hyperplasia, and lobular dysplasia, in many areas of apparently healthy thyroid tissue.
  • These microscopic changes indicate a high likelihood of disease involving the entire gland.

Conclusions:

  • Multinodular goiter frequently involves the entire thyroid gland microscopically.
  • Conservative surgical approaches may lead to recurrence due to undetected disease.
  • Total thyroidectomy may be the most effective treatment to prevent recurrence in multinodular goiter.