title: A randomized trial of hemithyroidectomy versus Dunhill for the surgical management of asymmetrical multinodular goiter.
abstract: OBJECTIVE
  To assess the immediate and long-term clinical results of 2 different surgical procedures for the treatment of asymmetrical multinodular goiter (AMG).
  
  
  BACKGROUND
  Half of the patients presenting with a single benign thyroid nodule have contralateral subclinical disease. There is a controversy whether these patients should be treated with hemithyroidectomy (HMT) or with a more extensive procedure.
  
  
  METHODS
  Adult patients with a benign unilateral dominant nodule and contralateral nodule(s) with a diameter of less than 10 mm detected on neck ultrasonography were randomized to HMT or Dunhill (DUN). Rates of complications, remnant growth, incidental carcinoma, and reoperation were assessed.
  
  
  RESULTS
  A total of 118 patients (F/M:110/8, mean age 43 years) were included and randomized: 65 to HMT and 53 to DUN. After randomization, 28 patients were excluded leaving 47 HMT and 43 DUN long-term (55 ± 35 months) evaluable patients. Mean nodule size was 38 and 6 mm for the dominant and contralateral nodules, respectively. No differences were found in operative time, accidental parathyroidectomy, parathyroid autotransplantation, or wound complications. Transient hypocalcemia was more common in DUN (30% vs 8%; P < 0.001). No permanent complications were observed. At the last follow-up visit, thyroid-stimulating hormone was similar in both groups. Remnant growth (20 vs 0%; P < 0.001), appearance of new nodules (55 vs 14%; P < 0.001), and overall reoperation rate (9.2 vs 1.8%, P = 0.2) were more common in HMT, mostly because of undiagnosed cancer requiring completion thyroidectomy. Thirty percent of HMTs developed hypothyroidism and required long-term T4 supplementation.
  
  
  CONCLUSIONS
  DUN appears superior to HMT for the treatment of AMG in terms of early reoperation for missed carcinomas and disease progression. Both procedures have a similarly uneventful postoperative course.
authors.affiliation: Endocrine Surgery Unit, Hospital del Mar, Passeig Maritim 25-29, Barcelona, Spain.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Sancho
authors.forename: Rosa
authors.initials: R
authors.lastname: Prieto
authors.forename: Juan P
authors.initials: JP
authors.lastname: Dueñas
authors.forename: Carles
authors.initials: C
authors.lastname: Ribera
authors.forename: Joaquim
authors.initials: J
authors.lastname: Ripollés
authors.forename: Alvaro
authors.initials: A
authors.lastname: Larrad
authors.forename: Antoni
authors.initials: A
authors.lastname: Sitges-Serra
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D006044:Goiter, Nodular / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation / Q000706:statistics & numerical data; D018709:Statistics, Nonparametric; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography