Standard-radical vs. function-preserving surgery of benign nodular goiter: a sonographic and biochemical 10-year follow-up study.
BACKGROUND
The necessary extent of thyroid resection in benign nodular goiter is under debate. The aim of our study was to compare the long-term outcome of different thyroid resection modes with special interest in the incidence of recurrent nodules and the use of oral thyroid hormone medication.


METHODS
We performed a follow-up examination of 109 patients (23 men and 86 women) having been operated for benign nodular goiter at our department 10 years ago. Unilateral resections and function-preserving resections of at least one thyroid lobe were classified as function-preserving (FP). Total thyroidectomy, Dunhill's operation and bilateral subtotal thyroidectomy were rated as standard-radical (STR). On follow-up, we recorded current oral thyroid hormone medication, thyroid function tests and ultrasound of the neck.


RESULTS
Seventy-three patients had FP resection (67%), while 36 were STR-operated (33%). The subsequent medical treatment was performed by dedicated endocrinologists (n = 19), internists (n = 11) or primary-care physicians (n = 59). Twenty patients had no medical attendance. Recurrent nodules were found in 13 cases in the FP group (18.6%) vs. 3 cases in the STR group (2.5%; p < 0.001). In both groups, about 80% of patients used thyroid hormone medication 10 years after operation.


CONCLUSIONS
There was no advantage in thyroid function tests nor lesser medication in the FP group. The risk for recurrent nodules was significantly higher in the FP than in the STR-operated patients.
Lehwald
N
N
Department of General-, Visceral- and Pediatric Surgery, University Hospital Duesseldorf, Duesseldorf, Germany.
Cupisti
K
K
Willenberg
H S
HS
Schott
M
M
Krausch
M
M
Raffel
A
A
Wolf
A
A
Brinkmann
K
K
Eisenberger
C F
CF
Knoefel
W T
WT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006043:Goiter, Endemic / Q000000981:diagnostic imaging* / Q000601:surgery*; D006044:Goiter, Nodular / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D006980:Hyperthyroidism / Q000209:etiology; D007037:Hypothyroidism / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D013960:Thyroid Function Tests; D013965:Thyroidectomy / Q000379:methods*; D013974:Thyroxine / Q000008:administration & dosage*; D014463:Ultrasonography
D013974:Thyroxine