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A randomized trial of hemithyroidectomy versus dunhill for the surgical management of asymmetrical multinodular goiter.
MedLine Citation:
PMID:  23095630     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
OBJECTIVE: : To assess the immediate and long-term clinical results of 2 different surgical procedures for the treatment of asymmetrical multinodular goiter (AMG).
BACKGROUND: : Half of the patients presenting with a single benign thyroid nodule have contralateral subclinical disease. There is a controversy whether these patients should be treated with hemithyroidectomy (HMT) or with a more extensive procedure.
METHODS: : Adult patients with a benign unilateral dominant nodule and contralateral nodule(s) with a diameter of less than 10 mm detected on neck ultrasonography were randomized to HMT or Dunhill (DUN). Rates of complications, remnant growth, incidental carcinoma, and reoperation were assessed.
RESULTS: : A total of 118 patients (F/M:110/8, mean age 43 years) were included and randomized: 65 to HMT and 53 to DUN. After randomization, 28 patients were excluded leaving 47 HMT and 43 DUN long-term (55 ± 35 months) evaluable patients. Mean nodule size was 38 and 6 mm for the dominant and contralateral nodules, respectively. No differences were found in operative time, accidental parathyroidectomy, parathyroid autotransplantation, or wound complications. Transient hypocalcemia was more common in DUN (30% vs 8%; P < 0.001). No permanent complications were observed. At the last follow-up visit, thyroid-stimulating hormone was similar in both groups. Remnant growth (20 vs 0%; P < 0.001), appearance of new nodules (55 vs 14%; P < 0.001), and overall reoperation rate (9.2 vs 1.8%, P = 0.2) were more common in HMT, mostly because of undiagnosed cancer requiring completion thyroidectomy. Thirty percent of HMTs developed hypothyroidism and required long-term T4 supplementation.
CONCLUSIONS: : DUN appears superior to HMT for the treatment of AMG in terms of early reoperation for missed carcinomas and disease progression. Both procedures have a similarly uneventful postoperative course.
Authors:
Juan J Sancho; Rosa Prieto; Juan P Dueñas; Carles Ribera; Joaquim Ripollés; Alvaro Larrad; Antoni Sitges-Serra
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of surgery     Volume:  256     ISSN:  1528-1140     ISO Abbreviation:  Ann. Surg.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  846-52     Citation Subset:  AIM; IM    
Affiliation:
*Endocrine Surgery Unit, Hospital del Mar, Barcelona †Hospital de Sant Joan, Martorell ‡Clínica del Rosario, Madrid, Spain.
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