Document Detail


The change in surgical practice from subtotal to near-total or total thyroidectomy in the treatment of patients with benign multinodular goiter.
MedLine Citation:
PMID:  18958517     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although total thyroidectomy is the procedure of choice in patients with thyroid carcinoma, this surgical approach has emerged as a surgical option to treat patients with benign multinodular goiter (BMNG), especially in endemically iodine-deficient regions. The aim of this study was to review our experience with patients with BMNG in an endemically iodine-deficient region treated by either subtotal or total/near-total thyroidectomy, and to document whether total or near-total thyroidectomy decreased the rate of completion thyroidectomy for incidentally diagnosed thyroid carcinoma in comparison to the patients with BMNG treated initially by subtotal thyroidectomy. METHODS: Two thousand five hundred ninety-two patients with BMNG were included. There were 1695 bilateral subtotal thyroidectomies (group 1) and 1211 total or near-total thyroidectomies (group 2) for BMNG during this period. All patients were euthyroid and had no history of hyperthyroidism, radiation exposure, or familial thyroid carcinoma. Any patient with preoperative or perioperative suspicion of malignancy or hyperthyroidism was excluded. RESULTS: Bilateral subtotal thyroidectomy was performed in 1695 patients (58.3%) in group 1 and total or near-total thyroidectomy in 1211 patients (41.7%), in group 2, respectively. The incidence of incidental thyroid carcinoma was found to be 7.2% (n = 210/2906). Although the rate of permanent hypoparathyroidim and transient or permanent unilateral recurrent laryngeal nerve (RLN) palsy were not significantly different between the two groups, transient hypoparathyroidism was significantly higher in group 2 than in group 1 (8.4% vs. 1.42%; p < 0.001, odds ratio [OR] = 52.98). The incidence of thyroid carcinoma was significantly higher in group 2 (10.7%, n = 129/1211) than in group 1 (4.68%, n = 81/1695) (p < 0.001; OR = 39.1).Thirty-eight patients in group 1 (2.24%) underwent completion thyroidectomy, whereas completion thyroidectomy has been not indicated in group 2 (p = 0.007). Two of 38 patients (5.26%) had thyroid papillary microcarcinoma on their remnant thyroid tissue. The rate of recurrent goiter was 7.1% in group 1. The average time to recurrence in group 1 was 14.9 +/- 8.7 years. Six of 121 patients with recurrent disease (4.95%) has been operated on. CONCLUSIONS: Subtotal thyroidectomy resulted in a significantly higher rate of completion thyroidectomy for incidentally diagnosed thyroid carcinoma compared with total or near-total thyroidectomy in patients with BMNG. The extent of surgical resection had no significant effect on the rate of permanent complications. We recommend total or near-total thyroidectomy in BMNG to prevent recurrence and to eliminate the necessity for early completion thyroidectomy in case of a final diagnosis of thyroid carcinoma.
Authors:
Serdar Tezelman; Ismail Borucu; Yasemin Senyurek Giles; Fatih Tunca; Tarik Terzioglu
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  World journal of surgery     Volume:  33     ISSN:  0364-2313     ISO Abbreviation:  World J Surg     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-02-16     Completed Date:  2010-01-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7704052     Medline TA:  World J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  400-5     Citation Subset:  IM    
Affiliation:
Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Cerrahi Monoblok, Capa-Topkapi, 34390 Istanbul, Turkey. stezelman@superonline.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Carcinoma, Papillary / diagnosis,  epidemiology
Female
Goiter, Nodular / surgery*
Humans
Hypoparathyroidism / epidemiology,  prevention & control
Incidence
Incidental Findings
Male
Middle Aged
Recurrence
Retrospective Studies
Thyroid Neoplasms / diagnosis,  epidemiology
Thyroidectomy / adverse effects,  methods*
Treatment Outcome
Vocal Cord Paralysis / epidemiology,  prevention & control

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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