Evaluation of Total Thyroidectomy for Treatment of Benign Diseases of Thyroid Gland
BACKGROUND: The controversy of using total thyroidectomy (TT) in treatment of benign thyroid diseases still remains controversial over the rates of complication, mostly recurrence nerve palsy and hypocalcemia, compared to non-total thyroidectomies. The latest reports in this field of research showed that that the number of complications of TT is decreasing as the skills of surgeons increase.
AIM: In this study, we reviewed 209 cases of total thyroidectomies for benign thyroid diseases where such surgery was indicated. The results were evaluated whether they support the previous reports that TT is save method of treatment of diffuse multinodular goiters, Graves’ disease thyroid adenomas with diffuse goiters and thyroiditis.
METHODS: Two hundred and nine patients, 36 males and 173 females, medium age 47 (17–77) operated with TT between 2016 and 2018 were included in the evaluation study. We evaluated the: Diagnosis, indications for operation, pre-operative medication administration, laryngeal recurrent nerve palsy, hypocalcemia, hypoparathyroidism, and patohistology findings. The follow-up for hypocalcemia and laryngeal nerve palsy was performed 1 year postoperatively.
RESULTS: The age of the patients was between 17 and 77 years, medium-range 47 years old. Of 209 patients, 173 (83%) were female and 36 (17%) male with a gender ratio of 1:4.8 males to females. Diagnoses before surgery were established as follows: Multinodular euthyroid goiter (MNEG) n = 106 (48.80%), multinodular toxic goiter n = 12 (5.74%), Graves’s disease n = 6 (2.87%), adenoma with multinodular goiter n = 73 (34.92%), and n = 16 (7.65%) patients with thyroiditis. Recurrence laryngeal nerve palsy (RLNP) occurred in 6 patients (2.87%), temporary within 3 months after the operation in 4 patients (1.92%) and permanent palsy within 6 months and more after an operation in 2 patients (0.95%). Voice hoarseness immediately and within 1 month after the operation was registered in 32 patients (15.3%). RLNP and hoarseness were registered mostly in patients with pre-operative problems, mostly with extra big MNEG. One of the permanent injuries of RLN was bilateral and all others were one sided. All patients were operated with normal pre-operative vocal cord movement findings. Post-operative hypocalcemia was registered in 35 patients (16.74%). Temporary nonsignificant hypocalcemia in 10 (4.78%), temporary significant hypocalcemia in 17 (8.13%), temporary severe hypocalcemia in 6 patients (2.87%), and permanent hypocalcemia in 2 patients (0.95%).
CONCLUSION: Many studies have shown that the rate of complications is almost even for TT and NTT done for benign and malignant diseases of thyroid gland. Our data have shown that the risk of post-operative complications with TT is proportional to the number of complicated pre-operative findings of benign thyroid glands.
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Gough IR, Wilkinson D. Total thyroidectomy for management of thyroid disease. World J Surg. 2000;24(8):962-5. https://doi. org/10.1002/bjs.4507 PMid:10865041
Bron LP, O’Brien CJ. Total thyroidectomy for clinically benign disease of the thyroid gland. Br J Surg. 2004;91(5):569-74. PMid:15122607
Pattou F, Combemale F, Fabre S, Carnaille B, Decoulx M, Wemeau JL, et al. Hypocalcaemia following thyroid surgery: Incidence and prediction of outcome. World J Surg. 1998;22(7):718-24. PMid:9606288
Gough IR. Total thyroidectomy: Indications, technique and training. Aust N Z J Surg. 1992;62(2):87-9. PMid:1586310
Delbridge L, Guinea AI, Reeve TS. Total thyroidectomy for bilateral benign multinodular goiter: Effect of changing practice. Arch Surg. 1999;134(12):1389-93. https://doi.org/10.1001/ archsurg.134.12.1389
De Roy van Zuidewijn DB, Songun I, Kievit J, van de Velde CJ. Complications of thyroid surgery. Ann Surg Oncol. 1995;2(1):56- 60. https://doi.org/10.1007/bf02303703 PMid:7834455
Younes N, Robinson B, Delbridge L. The aetiology, investigation and management of surgical disorders of the thyroid gland. Aust N Z J Surg. 1996;66(7):481-90. https://doi. org/10.1111/j.1445-2197.1996.tb00787.x PMid:8678880
Phillips AW, Fenwick JD, Mallick UK, Perros P. The impact of clinical guidelines on surgical management in patients with thyroid cancer. Clin Oncol (R Coll Radiol). 2003;15(8):485-9. https://doi.org/10.1016/s0936-6555(03)00195-x PMid:14690005
Beenken S, Roye D, Weiss H, Sellers M, Urist M, Diethelm A, et al. Extend of surgery for intermediate-risk well-differentiated thyroid cancer. Am J Surg. 2000;179(1):51-6. PMid:10737579
Friguglietti CU, Lin CS, Kulcsar MA. Total thyroidectomy for benign thyroid disease. Laryngoscope. 2003;113(10):1820-6. https://doi.org/10.1097/00005537-200310000-00030 PMid:14520113
Hu J, Zhao N. Total thyroidectomy as primary surgical management for thyroid disease: Surgical therapy experience from 5559 thyroidectomies in a less-developed region. World J Surg Oncol. 2016;14(1):20. PMid:26801233
Sultan HM, Ahmed HA, Sedhom HI. Evaluation of total thyroidectomy in benign thyroid diseases. Menoufia Med J. 2014;27(1):205-7. https://doi.org/10.4103/1110-2098.132807
Bellantone R, Lombard CP. Total thyroidectomy for management of benign thyroid disease: Review of 526 cases. World J Surg. 2002;26(12):1468-71. PMid:12360381
Di Donna V. A new strategy to estimate levothyroxine requirement after total thyroidectomy for benign thyroid disease. Thyroid. 2014;24(12):1759-64. https://doi.org/10.1089/thy.2014.0111 PMid:25268754
Toluee M, Hedayati-Emami MH, Barzegar-Savasari MR, Shahrousvand Y, Mobayen MR. Treatment outcome of total thyroidectomy for multinodular goiter. Zahedan J Res Med Sci. 2015;17(8):e1026. https://doi.org/10.17795/zjrms1026
Iddings D. Comparison of complications of total thyroidectomy in malignant vs. benign thyroid tumors. J Clin Oncol. 2008;26 Suppl 15:17012-2. https://doi.org/10.1200/jco.2008.26.15_suppl.17012
Delbridge L. Total thyroidectomy: The evolution of surgical technique. ANZ J Surg. 2003;73(9):761-8. https://doi. org/10.1046/j.1445-2197.2003.02756.x PMid:12956795
Wheeler MH. Total thyroidectomy for benign thyroid disease. Lancet. 1998;351(9115):1526-7. https://doi.org/10.1016/ s0140-6736(05)61116-6 PMid:10326531
Barczyński M, Konturek A, Hubalewska-Dydejczyk A. Five-year follow-up of a randomized clinical trial of total thyroidectomy versus Dunhill operation versus bilateral subtotal thyroidectomy for multinodular nontoxic goiter. World J Surg. 2010;34(6):1203- 13. https://doi.org/10.1007/s00268-010-0491-7 PMid:20174803
Vassiliou I, Tympa A. Total thyroidectomy as the single surgical option for benign and malignant thyroid disease: A surgical challenge. Arch Med Sci. 2013;9(1):74-8. https://doi. org/10.5114/aoms.2013.33065 PMid:23515861
Ram BR, Goud VS, Kumar DR, Venkanna M. Total thyroidectomy for benign thyroid disease: A prospective study. Int J Sci Stud. 2016;4(1):161-4.
Liu Q, Djuricin G, Prinz RA. Total thyroidectomy for benign thyroid disease. Surgery. 1998;123(1):2-7. https://doi.org/10.1016/ s0039-6060(98)70221-1 PMid:9457216
Agarwal G, Aggarwal V. Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter? An evidence-based review. World J Surg. 2008;32(7):1313-24. https://doi. org/10.1007/s00268-008-9579-8 PMid:18449595
Colak T, Akca T, Kanik A, Yapici D, Aydin S. Total versus subtotal thyroidectomy for the management of benign multinodular goiter in an endemic region. ANZ J Surg 2004;74(11):974-8. https:// doi.org/10.1111/j.1445-1433.2004.03139.x PMid:15550086
Efremidou EI, Papageorgiou MS, Liratzopoulos N, Manolas KJ. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: A review of 932 cases. Can J Surg. 2009;52(1):39-44. PMid:19234650
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