IS SUBTOTAL THYROIDECTOMY AN OBSOLETE INDICATION FOR THE MANAGEMENT OF BENIGN MULTINODULAR GOITER?

Introduction. In Our department the standard surgical procedure for multinodular goiter used to be Subtotal resection. Over the years, total thyroidectomy has progressively replaced subtotal resections and is performed in most of our patients at present. Patients and Methods. In a prospective cohort, observational Study, we assessed the immediate surgical Outcome in 742 consecutive patients with multinodular goiter (MNG), admitted for Surgery and operated in Our hospital. Of all patients, 664 were women (89.5%) and 78 men (11.5%), aged 15 to 85 years. mean (+/- SD) of 48 +/- 13.8 years. Pathology was done on frozen and permanent sections. The complications directly related to surgery ill Subtotal thyroidectomy (STT) were compared to total thyroidectomy (TT) or near-total thyroidectomy (NTT) patients: temporary hypoparathyroidism, temporary RLN injury, permanent hypoparathyroidism and permanent RLN injury. The chi(2) test (95% confidence interval) was used and values of p<0.05 were considered significant. Results. There were no significant differences among the patients with SST for MNG, NTT or TT, and TT for recurrent MNG or completion thyroidectomy, with respect to temporary and permanent RLN injury. Significant differences were found for temporary hypoparathyroidism in STT for MNG (9 Out of 361 patients, 2.45%) and NTT or TT for MNG (21 Out of 266 cases, 7.89%) (p<0.01) and between STT for MING (9 Out of 361 cases, 2.45%) and TT for recurrent MNG for completion thyroidectomy (8 out of 45 cases, 17.77%) (p<0.01) and no difference between NTT or TT for MING (21 out of 266 cases, 7.89%) and TT for recurrent MING or completion thyroidectomy (8 Out of 45 cases, 17.77%) (p=0.11). We registered no permanent hypoparathyroidism in Our patients. Conclusions. Total thyroidectomy is now the preferred option for the management of patients with bilateral benign MNG. However, TT is associated with a considerable rate of complications, higher than of STT. In patients with bilateral MNG and no malignancy, STT remains in our opinion, a valuable option.