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Is subtotal thyroidectomy an obsolete indication for the management of benign multinodular goiter?

Domenii publicaţii > Ştiinţe medicale + Tipuri publicaţii > Articol în revistã ştiinţificã

Autori: Muntean V, Domşa I, Ghervan C, Valea A, Fabian O

Editorial: Acta Endocrinologica, 5(4), p.471-488, 2009.

Rezumat:

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 (+/-177;SD) of 48 +/-177;13.8 years. Pathology
was done on frozen and permanent sections. The complications directly related to surgery
in 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 χ2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 MNG (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 MNG (21 out of 266 cases, 7.89%) and TT for recurrent MNG 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.

Cuvinte cheie: multinodular goiter, subtotal thyroidectomy, total thyroidectomy

URL: http://86.120.250.122:8082/2009/numarul4/fulltext/is%20subtotal%20thyroidectomy%20an%20obsolete%20indication%20for%20the%20management%20of%20benign%20multinodular%20goiter.pdf