Thyroid gland surgery in an endemic region

Area of Science:

• Endocrinology
• Surgical Oncology
• Thyroid Surgery

Background:

• Reoperative thyroid surgery presents unique challenges.
• Understanding trends in endemic regions is crucial for surgical planning.
• Thyroid surgery rates and indications vary globally.

Purpose of the Study:

• To evaluate the incidence, indications, and complications of reoperative thyroid surgery.
• To analyze trends in thyroid surgery over a 12-year period in an endemic region.
• To inform surgical strategies for reducing reoperation rates and associated morbidity.

Main Methods:

• Retrospective analysis of 1318 patients undergoing thyroid surgery between 1983 and 1994.
• Categorization of indications for primary and reoperative procedures.
• Comparison of complication rates, specifically recurrent laryngeal nerve palsy, between primary and secondary operations.

Main Results:

• Reoperation rate was 13.5% (166 patients).
• Indications for reoperation shifted towards premalignant/malignant tumors (+16%) and away from hyperthyroid disorders (-30%).
• Benign multinodular goiters were the most common indication for both primary and reoperative surgery.
• Recurrent laryngeal nerve palsy rates varied, with higher rates in reoperations, influenced by surgical policies.

Conclusions:

• Extensive resection of thyroid tissue during initial operations can significantly reduce the incidence of recurrent goiter.
• Implementing more extensive initial resections, such as increasing lobectomy rates, lowers morbidity and the need for reoperation.
• Strict indications for reoperation are advised, with modified approaches considered when necessary.