title: The advantage of near-total thyroidectomy to avoid postoperative hypoparathyroidism in benign multinodular goiter.
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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Istanbul Medical Faculty, Department of General Surgery, Istanbul University, 34340, Capa, Istanbul, Turkey, yerbil2003@yahoo.com
authors.forename: Yeşim
authors.initials: Y
authors.lastname: Erbil
authors.forename: Umut
authors.initials: U
authors.lastname: Barbaros
authors.forename: Artür
authors.initials: A
authors.lastname: Salmaslioğlu
authors.forename: Burcu Tulumoğlu
authors.initials: BT
authors.lastname: Yanik
authors.forename: Alp
authors.initials: A
authors.lastname: Bozbora
authors.forename: Selçuk
authors.initials: S
authors.lastname: Ozarmağan
mesh_terms: D000328:Adult; D002291:Carcinoma, Papillary / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D005260:Female; D006044:Goiter, Nodular / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007011:Hypoparathyroidism / Q000453:epidemiology / Q000517:prevention & control*; D015994:Incidence; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D019275:Radiopharmaceuticals / Q000627:therapeutic use; D013964:Thyroid Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D014826:Vocal Cord Paralysis / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals