The choice of the intervention in the surgical treatment of nontoxic diffuse multinodular goiter

The choice between sub-total (STT) and total (TT) thyroidectomy in surgical management of multinodular goitre should be based on the disease pathophysiology and the critical review of short and long-term results of these treatments. In order to make a comparative evaluation the authors carried out a retrospective analysis on a series of patients operated from 1970 to 1993 and on the results of a 16.3 years mean follow-up. Of 551 patients operated on the thyroid gland, 389 (70.6%) affected by multinodular goitre were considered. 340 were female and 49 male (39 years medium age). 341 (87.6%) underwent STT and 48 (12.4%) TT. Post-operative opotherapy was adjusted according to hormonal assays. Post-operative vocal cord motility and calcemia were assessed. A routine endocrinological follow-up protocol has been carried out on all patients since 1980. Transitory vocal cord palsy and hypocalcemia were significantly more frequent in TT, while permanent damage was not. Of 40 TT (complete 5 years mean follow-up, 97.5% of the patients reached euthyroidism with replacement therapy. Of 189 STT (complete 16.3 years mean follow-up), 61.4% of the patients received opotherapy. A recurrent goitre was ascertained in 39.1% of the total (73.3% in the patients not receiving opotherapy) and operated in 16.2% of the cases. According to the authors their results support the choice of TT as it matches the rationale of surgical treatment of multinodular non-toxic goitre based on the pathophysiology of the disease. Moreover it allows easy achievement of euthyroidism avoiding goitre relapse and subsequently re-operation, with an incidence of permanent recurrent nerve palsy and hypoparathyroidism not significantly different from that after STT.