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Analysis and prevention of recurrent goiter
J L Kraimps1, R Marechaud, D Gineste
1Department of Surgery, Jean Bernard Hospital, Poitiers University, France.
Surgery, Gynecology & Obstetrics
|April 1, 1993
Summary
Recurrent goiter occurred in 2.5% of patients, with multinodular goiter being a significant risk factor. Prevention strategies like intraoperative palpation are crucial, and thyroid-stimulating hormone (TSH) therapy may be reserved for high-risk individuals.
Area of Science:
- Endocrinology
- Surgical Oncology
- Thyroid Surgery
Background:
- Recurrent goiter necessitates reoperation, posing increased risks of hypoparathyroidism and vocal cord paralysis.
- Nodular recurrence rates after thyroidectomy vary, emphasizing the need for effective prevention and management strategies.
Purpose of the Study:
- To analyze the experience and outcomes of recurrent goiter following thyroidectomy.
- To identify risk factors for recurrent goiter and evaluate prevention strategies.
Main Methods:
- Retrospective analysis of 1,456 patients who underwent thyroidectomy between 1968 and 1983.
- Follow-up evaluation for 5 to 20 years post-initial surgery.
- Correlation analysis to identify factors associated with recurrence.
Main Results:
- Nodular recurrence was observed in 2.5% of patients (36 out of 1,456).
- Multinodular goiter was associated with a higher risk of recurrence (70% of recurrences).
- Recurrence was typically detected around 8 years post-thyroidectomy; reoperation carried risks of vocal cord paralysis and hypoparathyroidism.
Conclusions:
- Multinodular goiter is a significant risk factor for recurrent goiter.
- Intraoperative digital palpation of the thyroid gland is essential for preventing residual nodules.
- Systematic total thyroidectomy is not recommended for multinodular goiter due to the low recurrence rate; subtotal thyroidectomy is preferred.