[Role of total thyroidectomy in the treatment of benign thyroid diseases]

In 1990, total thyroidectomy (T.T.) was performed in 4% of all benign thyroid diseases and in 7% in case of diffuse benign thyroid diseases, operated on in our surgical unit. In 1995, this incidence of T.T. increased to 20% and 37% respectively. Several considerations can explain this rise in T.T. indications. Currently, the incidence of reoperations on benign goiters represents 4.5% of all our thyroid surgery. It can be considered as a failure of a first incomplete operation. Furthermore, most of goiter recurrences are medically treated and the recurrence rate is higher than the reoperation rate. In Grave's disease, surgery is indicated after medical treatment failure or for acute complications. In this case, the aim of surgery is radical cure of hyperthyroidism. Because evaluation of the weight of thyroid remnant for prevention of postoperative hypothyroidism is difficult, indication of T.T. with thyroxin replacement therapy can be proposed. Surgical excision of a multinodular goiter is indicated for large size lesions, tracheal compression or thyrotoxic evolution. Over the years subtotal thyroidectomy was performed for these benign lesions. Subtotal thyroidectomy leaves a diseased remnant gland. Attempts to suppress nodular recurrence by thyroxin treatment do not guarantee success. Then T.T. can be advocated since postoperative thyroxin therapy is often given after subtotal thyroidectomy to prevent hypothyroidism. Total thyroidectomy is an appropriate operation for the management of a benign thyroid disease because it precludes patients from requiring further surgery for recurrent diseases. However, it requires two conditions. In first, the patient must have the psychologic and economic capacity for a permanent medical therapy. The other is that the procedure be performed with low risks of complications in comparison with subtotal thyroidectomies. Currently recurrential palsy and hypoparathyroidism rates are evaluated in the literature between 0 and 3%.