[Total thyroidectomy vs subtotal thyroidectomy for plurinodular goiter. Analysis 1517 cases].

Area of Science:

• Endocrinology
• Surgical Oncology
• Pathology

Background:

• Surgical treatment for benign thyroid diseases remains debated, with varying approaches from conservative to extensive.
• This study addresses the controversy by advocating for total thyroidectomy.

Purpose of the Study:

• To establish total thyroidectomy as the optimal and most effective surgical therapy for benign thyroid diseases.
• To provide evidence supporting a radical surgical approach based on histological findings.

Main Methods:

• A retrospective analysis of 2136 patients with benign thyroid diseases treated between January 1985 and July 2008.
• Exclusion of patients with suspected or confirmed thyroid cancer.
• Review of surgical procedures, including total thyroidectomy, lobectomy, and near-total/subtotal thyroidectomy, alongside histological examination results.

Main Results:

• Goiter was the most common diagnosis (71%), with a significant proportion of recurrent goiters.
• Microcarcinoma (PTMC) was found in 6.9% of primary goiters.
• Total thyroidectomy was performed in 78% of cases, often due to histological findings indicating disease spread or potential for malignant transformation.

Conclusions:

• Histological examination of macroscopically healthy thyroid tissue revealed widespread disease and signs of evolving pathology.
• Residual thyroid parenchyma carries a risk of malignant degeneration.
• These findings strongly support a radical surgical approach, such as total thyroidectomy, for benign thyroid diseases to ensure complete disease eradication and prevent recurrence or malignancy.