title: The change in surgical practice from subtotal to near-total or total thyroidectomy in the treatment of patients with benign multinodular goiter.
abstract: BACKGROUND
  Although total thyroidectomy is the procedure of choice in patients with thyroid carcinoma, this surgical approach has emerged as a surgical option to treat patients with benign multinodular goiter (BMNG), especially in endemically iodine-deficient regions. The aim of this study was to review our experience with patients with BMNG in an endemically iodine-deficient region treated by either subtotal or total/near-total thyroidectomy, and to document whether total or near-total thyroidectomy decreased the rate of completion thyroidectomy for incidentally diagnosed thyroid carcinoma in comparison to the patients with BMNG treated initially by subtotal thyroidectomy.
  
  
  METHODS
  Two thousand five hundred ninety-two patients with BMNG were included. There were 1695 bilateral subtotal thyroidectomies (group 1) and 1211 total or near-total thyroidectomies (group 2) for BMNG during this period. All patients were euthyroid and had no history of hyperthyroidism, radiation exposure, or familial thyroid carcinoma. Any patient with preoperative or perioperative suspicion of malignancy or hyperthyroidism was excluded.
  
  
  RESULTS
  Bilateral subtotal thyroidectomy was performed in 1695 patients (58.3%) in group 1 and total or near-total thyroidectomy in 1211 patients (41.7%), in group 2, respectively. The incidence of incidental thyroid carcinoma was found to be 7.2% (n = 210/2906). Although the rate of permanent hypoparathyroidim and transient or permanent unilateral recurrent laryngeal nerve (RLN) palsy were not significantly different between the two groups, transient hypoparathyroidism was significantly higher in group 2 than in group 1 (8.4% vs. 1.42%; p < 0.001, odds ratio [OR] = 52.98). The incidence of thyroid carcinoma was significantly higher in group 2 (10.7%, n = 129/1211) than in group 1 (4.68%, n = 81/1695) (p < 0.001; OR = 39.1).Thirty-eight patients in group 1 (2.24%) underwent completion thyroidectomy, whereas completion thyroidectomy has been not indicated in group 2 (p = 0.007). Two of 38 patients (5.26%) had thyroid papillary microcarcinoma on their remnant thyroid tissue. The rate of recurrent goiter was 7.1% in group 1. The average time to recurrence in group 1 was 14.9 +/- 8.7 years. Six of 121 patients with recurrent disease (4.95%) has been operated on.
  
  
  CONCLUSIONS
  Subtotal thyroidectomy resulted in a significantly higher rate of completion thyroidectomy for incidentally diagnosed thyroid carcinoma compared with total or near-total thyroidectomy in patients with BMNG. The extent of surgical resection had no significant effect on the rate of permanent complications. We recommend total or near-total thyroidectomy in BMNG to prevent recurrence and to eliminate the necessity for early completion thyroidectomy in case of a final diagnosis of thyroid carcinoma.
authors.affiliation: Department of Surgery, Istanbul Faculty of Medicine, Istanbul University, Cerrahi Monoblok, Capa-Topkapi, 34390 Istanbul, Turkey. stezelman@superonline.com
authors.forename: Serdar
authors.initials: S
authors.lastname: Tezelman
authors.forename: Ismail
authors.initials: I
authors.lastname: Borucu
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Senyurek Giles
authors.forename: Fatih
authors.initials: F
authors.lastname: Tunca
authors.forename: Tarik
authors.initials: T
authors.lastname: Terzioglu
mesh_terms: D000328:Adult; D002291:Carcinoma, Papillary / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006044:Goiter, Nodular / Q000601:surgery*; D006801:Humans; D007011:Hypoparathyroidism / Q000453:epidemiology / Q000517:prevention & control; D015994:Incidence; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000453:epidemiology; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000453:epidemiology / Q000517:prevention & control