Surgical indications for toxic multinodular goitre

The aim of this study was to clarify the surgical indications and the effectiveness of total thyroidectomy in the treatment of toxic multinodular goitre. From January 1998 to May 2004, 70 patients underwent total thyroidectomy in our department because of toxic multinodular goitre. In 46 patients (65.7%) the indications for total thyroidectomy were: 25 compressive goitres, 12 cervico-mediastinal goitres, 2 cases of Pemberton's sign, 5 follicular nodules with cytological atypia, and 2 cases of suspected papillary carcinoma. In 24 patients (34.3%) with failure or intolerance of previous treatment, surgical indications were: 9 persistent and 5 recurrent hyperthyroidism after medical treatment; 6 patients with cardiotoxicity; 3 patients with recurrent disease after percutaneous ethanol injection; 1 patient with antithyroid drug intolerance. The mean postoperative hospital stay was 3.2 days (range: 2-9). Transient hypocalcaemia occurred in 6 patients (8.6%) and transient unilateral recurrent laryngeal nerve injury in another 3 patients (4.2%). None of the patients had permanent hypocalcaemia or permanent recurrent laryngeal nerve injury. All 70 treated patients relieved their symptoms and became biochemically hypothyroid after the operation. Total thyroidectomy results in a rapid, reliable resolution of hyperthyroidism and removal of multinodular goitre, requires no re-treatment, removes any coexisting malignancy, and post-surgical hypothyroidism is simple to treat.