Recurrent goiters

Abstract

A recurrent goiter is the regrowth of thyroid tissue after thyroidectomy. The causes of recurrence following surgery for the benign disease can be broadly attributed to inadequate surgery, embryological remnants left behind inadvertently, and the development of a malignancy in the remnant. Recurrence after surgery for the benign disease should be preventable. Subtotal thyroidectomy (STT) was the main operation for goiters until the 1980s. The main issue with a subtotal surgery is a recurrence. One of the primary reasons why STT fails can be attributed to the fact that STT does not treat the underlying generalized disease adequately. The consensus is emerging that the best surgical option for multinodular goiter is total thyroidectomy. Even after “total” thyroidectomy, there is recurrence, what is left behind is related to the three embryological remnants of thyroid, namely pyramidal lobe recurrences, recurrence of the tubercle of Zuckerkandl, and thyrothymic recurrences. The surgical technique at the initial total thyroidectomy must be meticulous, ensuring that all embryological remnants are excised properly. Goiter recurrence is a failure of surgical treatment of goiter. Inadequate surgery and failure to excise all thyroid tissues are two preventable causes for recurrence. The technique of reoperative thyroidectomy must include capsular dissection, removal of all embryological remnants, and parathyroid autotransplantation. Surgery for recurrent goiter is challenging. It is thought to entail a higher complication rate and complication rates may be high in inexperienced hands; low complication rates have been achieved in specialized centers. The fear of complications should not deter experienced surgeons from performing reoperative thyroid surgery. In terms of technique, the lateral approach to thyroid offers a good alternative for recurrent goiters. A meticulous technique and parathyroid autotransplantation will help minimize the complication rate.