title: Subtotal and near total versus total thyroidectomy for the management of multinodular goiter.
abstract: BACKGROUND
  The purpose of the present work was to compare rates of postsurgical complications following thyroidectomy for multinodular goiter through a retrospective multicenter cohort study.
  
  
  METHODS
  All cases of thyroidectomy (total-TT; near total-NT; and bilateral subtotal-ST) performed in two hospitals from 1990 to 2005 were studied to determine the incidence of complications after each procedure. Follow-up checked injury of laryngeal nerves, hypoparathyroidism, hypothyroidism, pathology recurrence, and appearance of neoplasm.
  
  
  RESULTS
  There were 6,223 cases: TT, n = 3,834 (61.6%); ST, n = 2,238 (36%); and NT, n = 151 (2.4%) NT). Of this total, 2,758 (44.3%) patients were men and 3,465 (55.7%) were women with a mean age of 48.7. Postoperative mean follow-up was 7 years, 2 months. Permanent recurrent laryngeal nerve (RLN) injury was observed in 1.4% in the TT group, 1.2% in the ST group, and 1.1% in the NT group (p > 0.1). Permanent hypocalcemia was observed in 2% in TT group, 1.9% in the ST group, and 2% in the NT group (p > 0.1). Permanent hypothyroidism occurred in all patients in the TT and NT groups, compared to 91% of the patients in the ST group (p > 0.1). Recurrence of benign disease was noted in 491 patients (20.5% of ST and NT cases combined; p < 0.05), n = 482 (21.5%) after ST and n = 9 (5.9%) after NT. Of the patients with recurrence, 173 needed a completion thyroidectomy. Malignant transformation was observed in 28 cases.
  
  
  CONCLUSIONS
  There is no statistically significant difference in complications among TT, NT, and ST groups. Partial thyroidectomies provide no decisive advantage over total thyroidectomies in terms of subsequent requirements of supplemental hormone therapy. The rate of reoperation in cases of recurrent pathology and incidental carcinoma was high.
authors.affiliation: Department of Otorhinolaryngology Head and Neck Surgery, Assaf HaRofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel. vaimed@yahoo.com
authors.forename: Michael
authors.initials: M
authors.lastname: Vaiman
authors.forename: Andrey
authors.initials: A
authors.lastname: Nagibin
authors.forename: Philippe
authors.initials: P
authors.lastname: Hagag
authors.forename: Alexey
authors.initials: A
authors.lastname: Buyankin
authors.forename: Julian
authors.initials: J
authors.lastname: Olevson
authors.forename: Nathan
authors.initials: N
authors.lastname: Shlamkovich
mesh_terms: D000328:Adult; D005260:Female; D006044:Goiter, Nodular / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods*