Total Thyroidectomy Versus Subtotal ThyroidectomyIn Multinodular Goitre– Our Experience

摘要

Introduction Total thyroidectomy for the management of benign Multinodular goiter is controversial and since the development of other subspecialties, it adds to further confusion. The present study aims to retrospectively compare the efficacy and morbidity of total thyroidectomy and subtotal thyroidectomy. Methods A total of 170 patients with multi nodular goiter were assigned to have either total thyroidectomy (n=100) or subtotal thyroidectomy (n=70) based on preoperative evaluation, FNAC and indications for surgery. Complications and hospital stay were also noted. Results There was no significant difference in the rate of major complications between the two procedures. There was no significant difference in distribution of post operative compl9ocations among the groups. Temporary hypoparathyroidism resulted in 37 (22%) patients in total out of which 28 (28%) belonged to total thyroidectomy group and 9 (13%) belonged to the subtotal thyroidectomy group respectively which was statistically insignificant. No permanent or temporary recurrent laryngeal nerve palsy was noted. Hematoma 2 (3%) and stitch granuloma 3 (4%) was recorded in Subtotal group. Incidental papillary carcinoma was noted in 10 (6%) patients with total thyroidectomy. Recurrence was noted in 20 (298%) of patients and 7 were taken up for further surgery and the rest managed with L-Thyroxine. 80% of the total thyroidectomies were devoid of any complications as compared to only 54.28% of subtotal Thyroidectomies without complications. Conclusion Subtotal thyroidectomy provides an unpredictable outcome and the risk of permanent complications is not less than or at par with total thyroidectomy, so there appears little or none logical reason to recommend subtotal thyroidectomy. In our experience total thyroidectomy is radical but a definitive treatment method without the risk of recurrence with a small incidence of major complications as that of a less radical procedure. Introduction Total thyroidectomy (TT) for the management of benign thyroid disorders is being increasingly accepted, although the indications are not well defined. All the treatment modalities have different types and incidences of morbidities. As a result, most surgeons have been looking for a treatment which results in the least recurrence and lowest complication rate. Many surgeons prefer Subtotal Thyroidectomy (ST) owing to the fact that the chances of permanent hypoparathyroidism are less and thought that lifelong medications are not required. As far as the fate of the recurrent laryngeal nerve is concerned, we believe the outcome varies from surgeon to surgeon. Contrary to the belief recurrence in Subtotal Thyroidectomy is not uncommon and completion surgery increases the risk of morbidity because of fibrosis. Thyromegaly apart from a neoplasia means that the gland is unable to produce enough hormones and it shows in the form of hyperplasia and after the surgery how it would be able to sustain the produce? Total thyroidectomy on the other hand, managed by total replacement therapy, has no chances of recurrence and morbidity is on par with subtotal thyroidectomy. Material & Method In the department of Otolaryngology, Pondicherry, India, a total number of 170 patients with Multinodular Goitre were considered for surgical management from Oct 2005 to Feb 2009. 160 (94%) were females and 10 (6%) were males. Age ranged from 21 to 44 years; mean age was 32.5 years ( tables 1, 2). 20 (12%) had breathing difficulties especially in the night and 80 (47%) had difficulty in swallowing ( table 3). These 100 (59%) patients with pressure symptoms were considered for total thyroidectomy and the rest 70 (41%) without pressure symptoms for subtotal thyroidectomy (table 4).All the patients were completely informed regarding the possible outcome and complications and accordingly consent was obtained. Routine blood tests, along with thyroid function tests, thyroid ultrasonography, serum calcium and fine needle aspira