[Role of total thyroidectomy in the treatment of multinodular goiter]

Although it may seem to be excessive, total thyroidectomy has recently been advocated by several authors for the treatment of diffuse multiheteronodular goiters. As a complement to a recent study on the thyroid function following thyroidectomy for benign goiters, the authors specify the role of this surgical technique, which had been reserved for the sole thyroid neoplasms for a long time. On the occasion of the presentation of a series of 75 cases gathered from 1989 to 1990, the justification of glandular resection is based on the publication of new pathogenetic data and on the absence of any increase in morbidity, subject to precise indications and to a strict technique aimed at preserving recurrents and locating the parathyroid glands while maintaining their vasculature. When aimed at reducing the frequency of recurrence of euthyroid and toxic diffuse multinodular goiters, total thyroidectomy might also contribute in reducing the morbidity of second surgery, at the expense of a permanent substitution therapy. While the choice of its indications must remain eclecty, thelong-term consequences of initial surgery with too restricted glandular exeresis must be recognized.