What constitutes adequate surgical therapy for benign nodular goiter?

It is our hypothesis that the extent of thyroid resection for benign nodular thyroid disease (NTD) should be based on the extent of disease.

Patients operated on for benign NTD from 1990 through 2007 were divided into 3 groups: those who underwent lobectomy for unilateral NTD (Group 1); near-total or total thyroidectomy for bilateral NTD (Group 2); and reoperation for NTD initially treated at other institutions (Group 3). The incidence of recurrence was determined for Groups 1 and 2 and the timing of diagnosis was compared to Group 3. Potential risk factors for recurrent disease were examined.

Five hundred forty-five patients were operated on for benign NTD. Contralateral disease was excluded in Group 1 patients using ultrasound (47.7%) and/or intraoperative palpation (100%). Five (1.9%) of 260 patients in Group 1 and 1 (0.4%) of 248 patients in Group 2 developed recurrent NTD after 7 +/- 4 (median = 8) and 4 y compared to a mean 19 +/- 11 (median = 20) y for the 37 patients in Group 3 following 1 to 3 previous thyroidectomies. Recurrent disease was diagnosed by physical exam in 24 (55.8%) and imaging in 19 (44.2%) patients. Thyroid hormone was required for postsurgical hypothyroidism in 70 (26.9%) patients in Group 1.

Thyroid lobectomy is optimal therapy when benign NTD is limited to 1 lobe, as evidenced by a 2% recurrence rate and maintenance of euthyroidism in 73% of patients. When NTD is bilateral, total thyroidectomy is indicated to eliminate recurrence, underscoring the importance of routine preoperative ultrasound.