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Total versus subtotal thyroidectomy in the management of multinodular goiter
M Marchesi1, M Biffoni, F Tartaglia
1Third Department of Surgery, University La Sapienza, Policlinico Umberto I, Rome, Italy.
Background:
The choice between subtotal and total thyroidectomy for multinodular goiter is controversial.
Material And Methods:
Subtotal and total thyroidectomy have been respectively performed in 108 and 451 euthyroid patients with multinodular goiter.
Results:
After subtotal and total thyroidectomy, transient recurrent laryngeal nerve (RLN) palsy occurred in 1 patient (0.9%) and 3 (0.6%), transient asymptomatic hypoparathyroidism in 27 (25%) and 131 (29%), and transient symptomatic hypoparathyroidism in 2 (1.8%) and 13 (2.9%), respectively (P = NS). After subtotal thyroidectomy, recurrence occurred in 27 patients (26%) Re-operation in 14 patients resulted in transient RLN palsy in 2 patients (14%), transient asymptomatic hypoparathyroidism in 6 (43 %) and transient symptomatic hypoparathyroidism in 2 (14%).
Conclusions:
The failure to demonstrate any 'hormonal advantage' in preserving thyroid tissue by subtotal thyroidectomy, and the low morbidity rate and no need for re-operation after primary total thyroidectomy, make the latter the procedure of choice for the management of non-toxic multinodular goiter.