Indications for Surgery and Significance of Unrecognized Cancer in Endemic Multinodular Goiter

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2012 Mar 8

PMID 22395348

Citations 10

Authors

Konstantinos Lasithiotakis

Evangelia Grisbolaki

Dimosthenis Koutsomanolis

Maria Venianaki

Ioannis Petrakis

Nikolaos Vrachassotakis

Emanuel Chrysos

Odysseas Zoras

George Chalkiadakis

Affiliations

Soon will be listed here.

Abstract

Background: The exclusion of cancer in endemic goiter is often difficult mainly because of the high number of nodules and the as-yet unclear natural history of diagnosed cancer in endemic goiter patients. In a large number of consecutive patients who were to undergo total thyroidectomy for endemic multinodular goiter, we assessed indications for surgery and thyroid cancer outcome.

Methods: All patients who were to undergo total thyroidectomy for diffuse multinodular goiter on histological examination between January 1990 and October 2008 were evaluated.

Results: Of the 1,161 patients included in the study, 252 were cases of thyroid cancer (21.7%). Sensitivity of thyroid ultrasound (US) and fine-needle aspiration cytology (FNAC) for cancer detection was 30.3 and 64.1%, respectively. Differentiated thyroid carcinoma accounted for most of the tumors (96%), with 54.8% of them being papillary microcarcinomas, while bilateral-multicentric cancer occurred in 20.3%. In multivariate analysis, younger age (p = 0.06), sonographic findings (p = 0.03), and presence of histological thyroiditis (p = 0.09) were independently associated with the occurrence of tumors with diameter greater than 2 cm. The percentage of transient and permanent postoperative complications were approximately 25 and below 2%, respectively. After a median follow-up time of 78.5 months, overall recurrence rate was 6.7% and disease-specific mortality was 1.2%.

Conclusion: As US and FNAC did not consistently detect cancer in patients with diffuse multinodular goiter in our endemic area, evidence-based indications for surgery in this group of patients is needed, although radical surgery and favorable tumor histology offer favorable outcomes in commonly diagnosed thyroid cancer after total thyroidectomy for endemic multinodular goiter.

Citing Articles

Prevalence and Clinical Risk Factors of Thyroid Cancer in Retrosternal Goiter: A Retrospective Comparative Study with Cervical Multinodular Goiter.

Prete F, De Luca G, Sgaramella L, Pasculli A, Di Meo G, Testini C J Clin Med. 2025; 14(2).

PMID: 39860494 PMC: 11766402. DOI: 10.3390/jcm14020489.

Liquid Biopsies in Follicular Thyroid Carcinomas-A Brief Report.

Hansen M, Bendtsen S, Jakobsen K, Schmidt A, Hahn C, von Buchwald C Diagnostics (Basel). 2024; 14(14).

PMID: 39061714 PMC: 11276045. DOI: 10.3390/diagnostics14141577.

Frequency of Thyroid Microcarcinoma in Patients Who Underwent Total Thyroidectomy with Benign Indication-A 5-Year Retrospective Review.

Magra V, Boulogeorgou K, Paschou E, Sevva C, Manaki V, Mpotani I Medicina (Kaunas). 2024; 60(3).

PMID: 38541194 PMC: 10972442. DOI: 10.3390/medicina60030468.

Incidence and Clinical Relevance of Incidental Papillary Carcinoma in Thyroidectomy for Multinodular Goiters.

Bove A, Manunzio R, Palone G, di Renzo R, Calabrese G, Perpetuini D J Clin Med. 2023; 12(8).

PMID: 37109106 PMC: 10144475. DOI: 10.3390/jcm12082770.

Risk Factors for Malignancy in Patients with Multinodular Goiter.

Fernandes G, Matos L, Dedivitis R Int Arch Otorhinolaryngol. 2023; 27(1):e138-e142.

PMID: 36714905 PMC: 9879639. DOI: 10.1055/s-0042-1748925.

References

Huysmans D, Hermus A, Edelbroek M, Barentsz J, Corstens F, Kloppenborg P . Radioiodine for nontoxic multinodular goiter. Thyroid. 1997; 7(2):235-9. DOI: 10.1089/thy.1997.7.235. View

Grubbs E, Rich T, Li G, Sturgis E, Younes M, Myers J . Recent advances in thyroid cancer. Curr Probl Surg. 2008; 45(3):156-250. DOI: 10.1067/j.cpsurg.2007.12.010. View

Bhagat M, Dhaliwal S, Bonnema S, Hegedus L, Walsh J . Differences between endocrine surgeons and endocrinologists in the management of non-toxic multinodular goitre. Br J Surg. 2003; 90(9):1103-12. DOI: 10.1002/bjs.4171. View

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

Moalem J, Suh I, Duh Q . Treatment and prevention of recurrence of multinodular goiter: an evidence-based review of the literature. World J Surg. 2008; 32(7):1301-12. DOI: 10.1007/s00268-008-9477-0. View

Muller P, Kabus S, Robens E, Spelsberg F . Indications, risks, and acceptance of total thyroidectomy for multinodular benign goiter. Surg Today. 2002; 31(11):958-62. DOI: 10.1007/s005950170002. View

Moon W, Jung S, Lee J, Na D, Baek J, Lee Y . Benign and malignant thyroid nodules: US differentiation--multicenter retrospective study. Radiology. 2008; 247(3):762-70. DOI: 10.1148/radiol.2473070944. View

Bellantone R, Lombardi C, Boscherini M, Raffaelli M, Tondolo V, Alesina P . Predictive factors for recurrence after thyroid lobectomy for unilateral non-toxic goiter in an endemic area: results of a multivariate analysis. Surgery. 2005; 136(6):1247-51. DOI: 10.1016/j.surg.2004.06.054. View

Barczynski M, Konturek A, Hubalewska-Dydejczyk A, Golkowski F, Cichon S, Nowak W . Five-year follow-up of a randomized clinical trial of total thyroidectomy versus Dunhill operation versus bilateral subtotal thyroidectomy for multinodular nontoxic goiter. World J Surg. 2010; 34(6):1203-13. DOI: 10.1007/s00268-010-0491-7. View

10.

Pappalardo G, Guadalaxara A, Frattaroli F, Illomei G, Falaschi P . Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports. Eur J Surg. 1998; 164(7):501-6. DOI: 10.1080/110241598750005840. View

11.

Bradly D, Reddy V, Prinz R, Gattuso P . Incidental papillary carcinoma in patients treated surgically for benign thyroid diseases. Surgery. 2009; 146(6):1099-104. DOI: 10.1016/j.surg.2009.09.025. View

12.

Mishra A, Agarwal A, Agarwal G, Mishra S . Total thyroidectomy for benign thyroid disorders in an endemic region. World J Surg. 2001; 25(3):307-10. DOI: 10.1007/s002680020100. View

13.

Baier N, Hahn P, Gervais D, Samir A, Halpern E, Mueller P . Fine-needle aspiration biopsy of thyroid nodules: experience in a cohort of 944 patients. AJR Am J Roentgenol. 2009; 193(4):1175-9. DOI: 10.2214/AJR.08.1840. View

14.

Moon H, Kwak J, Kim E, Kim M, Park C, Chung W . The combined role of ultrasound and frozen section in surgical management of thyroid nodules read as suspicious for papillary thyroid carcinoma on fine needle aspiration biopsy: a retrospective study. World J Surg. 2009; 33(5):950-7. DOI: 10.1007/s00268-009-9984-7. View

15.

Miccoli P, Minuto M, Galleri D, dAgostino J, Basolo F, Antonangeli L . Incidental thyroid carcinoma in a large series of consecutive patients operated on for benign thyroid disease. ANZ J Surg. 2006; 76(3):123-6. DOI: 10.1111/j.1445-2197.2006.03667.x. View

16.

Lin J, Kuo S, Chao T, Hsueh C . Incidental and nonincidental papillary thyroid microcarcinoma. Ann Surg Oncol. 2008; 15(8):2287-92. DOI: 10.1245/s10434-008-9958-2. View

17.

Giles Y, Boztepe H, Terzioglu T, Tezelman S . The advantage of total thyroidectomy to avoid reoperation for incidental thyroid cancer in multinodular goiter. Arch Surg. 2004; 139(2):179-82. DOI: 10.1001/archsurg.139.2.179. View

18.

Zambudio A, Rodriguez J, Riquelme J, Soria T, Canteras M, Parrilla P . Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery. Ann Surg. 2004; 240(1):18-25. PMC: 1356369. DOI: 10.1097/01.sla.0000129357.58265.3c. View

19.

Efremidou E, Papageorgiou M, Liratzopoulos N, Manolas K . The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases. Can J Surg. 2009; 52(1):39-44. PMC: 2637645. View

20.

Piraneo S, Vitri P, Galimberti A, Guzzetti S, Salvaggio A, Bastagli A . Recurrence of goitre after operation in euthyroid patients. Eur J Surg. 1994; 160(6-7):351-6. View