[Nodular thyreopathies. Results of 1300 operations]

To evaluate the results of surgery for nodular thyreopathies, 1300 cases operated on from January 1974 to December 1987 were reviewed. 842 patients (64.7%) were female; the average age, 41 +/- 2.4 year. Thyroid pathology was represented by solitary nodule in 643 cases (49.4%); multinodular goitre in 559 cases (43.0%) (377 euthyroid and 182 hyperthyroid patients); retrosternal in 78 cases (5.9%); recurrent goitre in 20 cases (1.5%). The patients underwent total thyroidectomy (525 cases); sub-total thyroidectomy (132 cases); total lobectomy (643 cases). Post-operative follow-up (clinical exam; T3, T4, tsh analysis); was performed at 3, 6, 12 and 24 months. The overall mortality rate was 0.13 percent (two deaths, respectively after total-0.1% - and sub-total thyroidectomy-0.7%). Immediate post-operative complications were: recurrent palsy (9 cases, 0.6%); acute respiratory failure (2 cases, 0.7%); hypoparathyroidism (3 cases, 0.2%). Late sequelae (1-3 year) were recurrent nerve palsy in 7 patients (0.5%); hypoparathyroidism in one case (0.07%). 46 patients which underwent sub-total thyroidectomy were hypothyroid to T3, T4, TSH analysis and required thyroxine support treatment. New concepts on the pathogenesis of multinodular goitre (growth autonomy of goitre human tissue; failure of thyreosuppressive therapy to prevent relapses after sub-total thyroidectomy) and the results of this review of 1300 interventions seems confirm the indication to total thyroidectomy in the treatment of both euthyroid and toxic multinodular goitre.