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Minimal Invasive Resection of Large Retrosternal Thyroid Goiter
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Risks Associated With Extent of Surgical Management for Benign, Non-Toxic Goiter.

Jacob S Brady1, Neeraja Konuthula2, Austin Lam2

  • 1Department of Otolaryngology - Head and Neck Surgery Case Western Reserve University Cleveland Ohio USA.

Laryngoscope Investigative Otolaryngology
|October 29, 2025
PubMed
Summary
This summary is machine-generated.

Total thyroidectomy for benign goiter significantly increases complication risks, including hypocalcemia and recurrent laryngeal nerve dysfunction, compared to lobectomy. This study quantifies these risks, informing surgical decisions for thyroid disease.

Keywords:
goiter treatmentshared decision makingsurgical risksthyroid surgery

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Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Health Services Research

Background:

  • Thyroidectomy is a common surgery for benign thyroid goiter globally.
  • The optimal extent of thyroid surgery (total vs. lobectomy) remains debated.
  • Quantifying complication differences between total thyroidectomy and lobectomy is crucial.

Purpose of the Study:

  • To compare the risk of surgical complications between total thyroidectomy and thyroid lobectomy.
  • To quantify the magnitude of the risk difference in postoperative complications.

Main Methods:

  • Retrospective analysis of the National Surgical Quality Improvement Program (NSQIP) datasets (2016-2020).
  • Comparison of outcomes between lobectomy (CPT 60220) and total thyroidectomy (CPT 60240).
  • Multivariable analyses controlled for confounding factors to assess independent associations with complications.

Main Results:

  • Total thyroidectomy was linked to significantly higher odds of overall complications (OR=1.8) and thyroidectomy-specific complications (OR=1.9).
  • Increased risks observed for recurrent laryngeal nerve dysfunction, various forms of hypocalcemia, unplanned readmission, longer hospital stays, and operative times.
  • Specific complication odds ratios: RLN dysfunction (1.5), hypocalcemia prior to discharge (3.8), after discharge (4.6), and severe hypocalcemia (5.4).

Conclusions:

  • Total thyroidectomy is associated with significantly greater surgical and medical complication rates and readmissions compared to lobectomy, even after controlling for comorbidities.
  • Findings support informed shared decision-making regarding the extent of thyroid surgery for benign goiter.
  • This study provides the largest dataset to date for comparing thyroidectomy complication risks.