The recurrent goiter: prevention and management.
OBJECTIVE
Conservative surgery of thyroid is followed by recurrence in 2 to 70% of cases in an 8-20 years period. The surgical treatment of such recurrence is affected by higher morbidity than a primary total thyroidectomy. We wanted verify in our series this difference and discuss motivations for conservative or radical surgery of goiter.


METHODS
We compared a series of 91 primary total thyroidectomy (A) with 11 cases of total thyroidectomy for recurrence (B) performed between 2001 and 2005.


RESULTS
Postoperative complications were: Transient hypocalcemia 7 (7.69%) in A and 3 (27%) in B, Permanent hypocalcemia only 1 (9%) in B, Transient RLN deficit 2 (2.1%) in A and 2 (18.1%) in B.


CONCLUSIONS
Due to the need of a lifelong therapy with LT4 no utility is observed in conservative surgery of thyroid. Further, in primary surgery, differences in incidence of perioperative complications cannot be advocated to justify a conservative approach. Sophisticated technologies are not able to prevent all damages to parathyroid or to recurrent nerves when operating on recurrent goiter. Our experience confirms the results of a review of literature on this topic: the best management of recurrent goiter is its prevention by primary total thyroidectomy.
Cappellani
Alessandro
A
University of Catania Medical School, Policlinico, Dept of Surgery, Azienda Ospedaliero-Universitaria Policlinico di Catania, Catania, Italy.
Di Vita
Maria
M
Zanghì
Antonio
A
Lo Menzo
Emanuele
E
Cavallaro
Andrea
A
Alfano
Giovanni
G
Giuffrida
Dario
D
D000368:Aged; D000369:Aged, 80 and over; D002986:Clinical Trials as Topic; D005260:Female; D005500:Follow-Up Studies; D006042:Goiter / Q000601:surgery*; D006801:Humans; D006996:Hypocalcemia / Q000175:diagnosis / Q000209:etiology; D007902:Length of Stay; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis; D061226:Recurrent Laryngeal Nerve Injuries; D012086:Reoperation; D055502:Secondary Prevention; D013965:Thyroidectomy; D013974:Thyroxine / Q000008:administration & dosage / Q000627:therapeutic use; D013997:Time Factors
D013974:Thyroxine