[Development and outcomes of the surgical management of multinodular goiter]

The aims of this study were to: 1. Define our criteria and the results obtained in the surgical management of multinodular goiter (MNG); 2. Compare the results of partial thyroidectomies with those of total thyroidectomies; 3. Determine the incidence of "hidden" carcinomas diagnosed as MNG; 4. Define the most suitable treatment of MNG.

We performed a retrospective study (1999-2005) of 190 patients with MNG. Clinical characteristics, the diagnostic procedures used, surgical indications, the strategy employed, and biopsy results were analyzed. Overall morbidity and mortality were evaluated and statistical comparison of the morbidity-mortality rate between partial and total thyroidectomies was performed.

Depending on the patients, diagnostic procedures consisted of ultrasonography, gammagraphy, computed tomography, and fine-needle aspiration (FNA). Surgical indication was established by compressive syndrome, endothoracic prolongation, rapid growth, suspected malignancy, nodular hyperthyroidism, the endocrinologist's criteria, and the patient's wishes. The surgical strategy showed a change in favor of radical surgery. The most common histologic diagnosis was nodular hyperplasia, but 16 carcinomas were "hidden" under a diagnosis of MNG (8.5%). There was no mortality. Morbidity, however, did exist, with the poorest results, showing statistically significant differences, occurring in total thyroidectomies.

1. Ultrasonography and FNA were routinely used for diagnosis. Surgical treatment tended to be radical. We believe that identification of recurrences and parathyroid disease is mandatory; 2. Morbidity was greater with total thyroidectomy; 3. Of patients who underwent surgery for MNG, 8.5% had a hidden thyroid carcinoma; 4. With certain limitations, total thyroidectomy is the most suitable therapy.