The Advantage of Near-total Thyroidectomy to Avoid Postoperative Hypoparathyroidism in Benign Multinodular Goiter

Overview

Journal Langenbecks Arch Surg

Specialty General Surgery

Date 2006 Oct 6

PMID 17021791

Citations 17

Authors

Yesim Erbil

Umut Barbaros

Artur Salmaslioglu

Burcu Tulumoglu Yanik

Alp Bozbora

Selcuk Ozarmagan

Affiliations

Soon will be listed here.

Abstract

Background: In recent years, total or near-total thyroidectomy has emerged as a surgical option to treat patients with multinodular goiter, especially in endemic iodine-deficient regions. The aim of this study was to compare the complication rates of total and near-total thyroidectomy in multinodular goiter and the incidence of thyroid cancer requiring radioactive iodine ablation and completion thyroidectomy between groups.

Study Design: Patients with euthyroid multinodular goiter without any preoperative suspicion of malignancy, history of familial thyroid cancer, or previous exposure to radiation were randomized (according to a random table) to total thyroidectomy (group 1, n = 104) and near-total thyroidectomy leaving less than 2 g (group 2, n = 112).

Results: There were no persistent complications. The incidence of transient hypoparathyroidism in group 1 (26%) was significantly higher than in group 2 (9.8%) (p < 0.001). The rate of asymptomatic hypocalcemia in group 2 (7.4%) was lower than in group 1 (27%) (p < 0.001). The incidence of papillary cancer was 9.6% in group 1 and 12.5% in group 2 (p > 0.05). None of the patients underwent completion thyroidectomy before ablative therapy. Ten patients were found to have the histological criteria for radioactive iodine ablation. Of these 10 patients, four were in group 1 and six were in group 2 (p > 0.05).

Conclusion: In conclusion, we recommend near-total thyroidectomy in multinodular goiter instead of total or subtotal thyroidectomy. While near-total thyroidectomy and total thyroidectomy obviate the need for completion thyroidectomy in incidentally found thyroid cancer, and while there is no difference in the rate of recurrent laryngeal nerve palsy between the two methods, near-total thyroidectomy causes a significantly lower rate of hypoparathyroidism compared to total thyroidectomy.

Citing Articles

Total Thyroidectomy Versus Partial Thyroidectomy for Non-Toxic Multinodular Goiter: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Al-Hakami H, Kouther D, Alsharef J, Kouther M, Abualola A, Ghaddaf A Indian J Surg Oncol. 2024; 15(4):920-930.

PMID: 39555356 PMC: 11564502. DOI: 10.1007/s13193-024-02057-y.

Total vs less than total thyroidectomy for benign multinodular non-toxic goiter: an updated systematic review and meta-analysis.

Bharath S, Yadav S, Sharma D, Jha C, Mishra A, Mishra S Langenbecks Arch Surg. 2023; 408(1):200.

PMID: 37204607 DOI: 10.1007/s00423-023-02941-1.

Goiter surgery recommendations in sub-Saharan Africa in humanitarian cooperation.

Martinez J, Gonzalez M, Hernandez Q, Rodriguez M, Torregrosa N, Gil E Laryngoscope Investig Otolaryngol. 2022; 7(2):417-424.

PMID: 35434333 PMC: 9008146. DOI: 10.1002/lio2.764.

Etiology and Diagnosis of Permanent Hypoparathyroidism after Total Thyroidectomy.

Sitges-Serra A J Clin Med. 2021; 10(3).

PMID: 33540657 PMC: 7867256. DOI: 10.3390/jcm10030543.

Completion thyroidectomy: is timing important for transcervical and remote access approaches?.

Duenas J, Duque C, Cristancho L, Mendez M World J Otorhinolaryngol Head Neck Surg. 2020; 6(3):165-170.

PMID: 33073211 PMC: 7548381. DOI: 10.1016/j.wjorl.2020.02.006.

References

Mishra A, Agarwal G, Agarwal A, Mishra S . Safety and efficacy of total thyroidectomy in hands of endocrine surgery trainees. Am J Surg. 1999; 178(5):377-80. DOI: 10.1016/s0002-9610(99)00196-8. View

Sturniolo G, Dalia C, Tonante A, Gagliano E, Taranto F, Lo Schiavo M . The recurrent laryngeal nerve related to thyroid surgery. Am J Surg. 1999; 177(6):485-8. DOI: 10.1016/s0002-9610(99)00101-4. View

Frates M, Benson C, Charboneau J, Cibas E, Clark O, Coleman B . Management of thyroid nodules detected at US: Society of Radiologists in Ultrasound consensus conference statement. Radiology. 2005; 237(3):794-800. DOI: 10.1148/radiol.2373050220. View

Goncalves Filho J, Kowalski L . Surgical complications after thyroid surgery performed in a cancer hospital. Otolaryngol Head Neck Surg. 2005; 132(3):490-4. DOI: 10.1016/j.otohns.2004.09.028. View

Schlumberger M, Berg G, Cohen O, Duntas L, Jamar F, Jarzab B . Follow-up of low-risk patients with differentiated thyroid carcinoma: a European perspective. Eur J Endocrinol. 2004; 150(2):105-12. DOI: 10.1530/eje.0.1500105. View

Misiolek M, Waler J, Namyslowski G, Kucharzewski M, PODWINSKI A, Czecior E . Recurrent laryngeal nerve palsy after thyroid cancer surgery: a laryngological and surgical problem. Eur Arch Otorhinolaryngol. 2002; 258(9):460-2. DOI: 10.1007/s004050100370. View

Hay I, Thompson G, Grant C, Bergstralh E, Dvorak C, Gorman C . Papillary thyroid carcinoma managed at the Mayo Clinic during six decades (1940-1999): temporal trends in initial therapy and long-term outcome in 2444 consecutively treated patients. World J Surg. 2002; 26(8):879-85. DOI: 10.1007/s00268-002-6612-1. View

Acun Z, Comert M, Cihan A, Ulukent S, Ucan B, Karadeniz Cakmak G . Near-total thyroidectomy could be the best treatment for thyroid disease in endemic regions. Arch Surg. 2004; 139(4):444-7. DOI: 10.1001/archsurg.139.4.444. View

Rojdmark J, Jarhult J . High long term recurrence rate after subtotal thyroidectomy for nodular goitre. Eur J Surg. 1995; 161(10):725-7. View

10.

Bron L, OBrien C . Total thyroidectomy for clinically benign disease of the thyroid gland. Br J Surg. 2004; 91(5):569-74. DOI: 10.1002/bjs.4507. View

11.

Koyuncu A, Dokmetas H, Turan M, Aydin C, Karadayi K, Budak E . Comparison of different thyroidectomy techniques for benign thyroid disease. Endocr J. 2004; 50(6):723-7. DOI: 10.1507/endocrj.50.723. View

12.

Pellegriti G, Scollo C, Lumera G, Regalbuto C, Vigneri R, Belfiore A . Clinical behavior and outcome of papillary thyroid cancers smaller than 1.5 cm in diameter: study of 299 cases. J Clin Endocrinol Metab. 2004; 89(8):3713-20. DOI: 10.1210/jc.2003-031982. View

13.

Pearce E, Braverman L . Papillary thyroid microcarcinoma outcomes and implications for treatment. J Clin Endocrinol Metab. 2004; 89(8):3710-2. DOI: 10.1210/jc.2004-1189. View

14.

Abboud B, Sargi Z, Akkam M, Sleilaty F . Risk factors for postthyroidectomy hypocalcemia. J Am Coll Surg. 2002; 195(4):456-61. DOI: 10.1016/s1072-7515(02)01310-8. View

15.

Bellantone R, Lombardi C, Bossola M, Boscherini M, De Crea C, Alesina P . Total thyroidectomy for management of benign thyroid disease: review of 526 cases. World J Surg. 2002; 26(12):1468-71. DOI: 10.1007/s00268-002-6426-1. View

16.

Ozbas S, Kocak S, Aydintug S, Cakmak A, Demirkiran M, Wishart G . Comparison of the complications of subtotal, near total and total thyroidectomy in the surgical management of multinodular goitre. Endocr J. 2005; 52(2):199-205. DOI: 10.1507/endocrj.52.199. View

17.

Prim M, De Diego J, Hardisson D, Madero R, Gavilan J . Factors related to nerve injury and hypocalcemia in thyroid gland surgery. Otolaryngol Head Neck Surg. 2001; 124(1):111-4. DOI: 10.1067/mhn.2001.112305. View

18.

Chow S, Law S, Chan J, Au S, Yau S, Lau W . Papillary microcarcinoma of the thyroid-Prognostic significance of lymph node metastasis and multifocality. Cancer. 2003; 98(1):31-40. DOI: 10.1002/cncr.11442. View

19.

Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi P . Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg. 2004; 28(3):271-6. DOI: 10.1007/s00268-003-6903-1. View

20.

Chao T, Jeng L, Lin J, Chen M . Reoperative thyroid surgery. World J Surg. 1997; 21(6):644-7. DOI: 10.1007/s002689900287. View