Total versus Subtotal Thyroidectomy in the Management of Multinodular Goiter

Abstract

Background. The choice between subtotal and total thyroidectomy for multinodular goiter is controversial. Material and Methods. Subtotal and total thyroidectomy have been respectively performed in 108 and 451 euthyroid patients with multinodular goiter. Results. After subtotal and total thyroidectomy, transient recurrent laryngeal nerve (RLN) palsy occurred in 1 patient (0.9%) and 3 (0.6%), transient asymptomatic hypoparathyroidism in 27 (25%) and 131 (29%), and transient symptomatic hypoparathyroidism in 2 (1.8%) and 13 (2.9%), respectively (P = NS). After subtotal thyroidectomy, recurrence occurred in 27 patients (26%) Re-operation in 14 patients resulted in transient RLN palsy in 2 patients (14%), transient asymptomatic hypoparathyroidism in 6 (43%) and transient symptomatic hypoparathyroidism in 2 (14%). Conclusions. The failure to demonstrate any 'hormonal advantage' in preserving thyroid tissue by subtotal thyroidectomy, and the low morbidity rate and no need for re-operation after primary total thyroidectomy, make the latter the procedure of choice for the management of non-toxic multinodular goiter.