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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 27  |  Issue : 1  |  Page : 205-207

Evaluation of total thyroidectomy in benign thyroid diseases


Department of Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission12-May-2013
Date of Acceptance29-Jul-2013
Date of Web Publication20-May-2014

Correspondence Address:
Hany Ibrahim Sedhom
Department of Surgery, Faculty of Medicine, Menoufia University, Fisha El kobra, Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.132807

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  Abstract 

Objectives
The aim of the study was to evaluate the role of total thyroidectomy in benign thyroid diseases such as simple multinodular goiter, secondary toxic goiter, diffuse toxic goiter relapsing after full medical treatment, and selected cases of thyroiditis (Hashimoto's thyroiditis).
Background
The extent of thyroidectomy in benign thyroid enlargement remains a matter of debate and shows a large spectrum of management strategies.
Patients and methods
We conducted a prospective observational study by collecting data from 40 patients in Menoufia university hospital between April 2010 and October 2011. All patient groups were subjected to investigations such as complete blood count, T3, T4, TSH, and calcium level.
Results
Of the 40 patients operated upon by total thyroidectomy in our study, eight patients (20%) suffered from complications: six patients (15%) suffered from transient hypoparathyroidism, one patient (2.5%) suffered from unilateral partial recurrent laryngeal nerve injury, and one patient (2.5%) suffered from difficult intubation.
Conclusion
The study showed that total thyroidectomy is recommended as a routine procedure of choice in benign thyroid diseases because it avoids leaving residual unhealthy thyroid tissue liable for recurrence with or without superimposed malignancy.

Keywords: Benign thyroid diseases, subtotal thyroidectomy, total thyroidectomy


How to cite this article:
Sultan HM, Ahmed HA, Sedhom HI. Evaluation of total thyroidectomy in benign thyroid diseases. Menoufia Med J 2014;27:205-7

How to cite this URL:
Sultan HM, Ahmed HA, Sedhom HI. Evaluation of total thyroidectomy in benign thyroid diseases. Menoufia Med J [serial online] 2014 [cited 2020 Feb 17];27:205-7. Available from: http://www.mmj.eg.net/text.asp?2014/27/1/205/132807


  Introduction Top


Total thyroidectomy has an important role in the management of patients with benign diseases when both lobes of the thyroid gland are involved. This approach avoids recurrence and increased risk of morbidity associated with secondary operation [1].

The rate of complications associated with total thyroidectomy, namely recurrent nerve palsy, hypocalcemia, wound infection, and secondary hemorrhage, did not differ significantly from that associated with subtotal thyroidectomy. These findings indicate that total thyroidectomy is an acceptable surgical alternative in benign multinodular goiters [2].

Toxic multinodular goiter is an indication for radical treatment. Medical treatment is required before surgery. Total thyroidectomy is used increasingly, providing a definitive cure for toxic hyperthyroidism and avoiding the risk for recurrence. With increasing surgical skill, the risk for RLN and parathyroid gland injury is greatly reduced [3].

Total thyroidectomy is the treatment of choice in multinodular goiter and thyroiditis, when there is bilateral gland involvement posterior to the middle thyroid veins, and in Graves'disease because it decreases the likelihood of future repeated operations for recurrent disease and thus the associated risks, when performed safely [4].


  Patients and methods Top


The study included 40 patients with different benign thyroid diseases who were admitted to Menoufia university hospital between April 2010 and October 2011. The patient group was subjected to complete history-taking and examination.

The patient group was subjected to investigations such as complete blood count, T3, T4, TSH, neck ultrasonography, chest radiograph, and fine needle aspiration cytology.

Statistical analysis

The data were coded, entered, and processed on an IBM-PC personal computer using SPSS (version 15). P-value less than 0.05 was considered the cut-off value for significance [5]. The χ2 -test was used to test the association between variables for categorical data. The Fisher exact test was performed for the values in the table, which were less than 5. Odds ratio and confidence interval were used to detect the risk factors of diseases.


  Results Top


The study was conducted during the period between April 2010 and October 2011 at surgery department, Menoufia University Hospital. Forty patients with different thyroid diseases were included in this study. Of the 40 patients operated upon by total thyroidectomy in our study, eight patients (20%) suffered from complications: six patients (15%) suffered from transient hypoparathyroidism [four latent tetany (10%) and two manifest tetany (5%)], one patient (2.5%) suffered from unilateral partial recurrent laryngeal nerve injury, and one patient (2.5%) suffered from difficult intubation. T3 and T4 levels in blood were determined in all patients and revealed that 28 patients (70%) were euthyroid (normal T3, T4), two patients (5%) were hypothyroid, and the remaining 10 patients (25%) were hyperthyroid (toxic). Gland nodularity was found in 36 patients (90%), tracheal shift in two patients (5%), and retrosternal extension in two patients (5%). Indications of total thyroidectomy, complications of total thyroidectomy, local clinical findings and thyroid profiles can be shown in [Table 1],[Table 2],[Table 3] and [Table 4] respectively.
Table 1: Indications of total thyroidectomy in 40 patients

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Table 2: Complications of total thyroidectomy

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Table 3: Local clinical findings in 40 patients

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Table 4: Thyroid profile in 40 patients

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  Discussion Top


The extent of thyroidectomy in the management of benign thyroid enlargement remains a matter of debate and shows a large spectrum of management strategies.

The aim of these strategies was to perform the most effective treatment with least number of complications and without the need for a second intervention, which is difficult and carries more complications to the patient.

This study aims to evaluate the value, safety, and visibility of the routine use of total thyoidectomy in bilateral benign thyroid diseases, with special emphasis on the incidence of two major postoperative complications namely recurrent laryngeal nerve injury and hypoparathyroidism.

Total thyroidectomy is a logical treatment when the pathology involves both lobes and if there is a high risk of recurrence as in benign multinodular goiter and Graves' disease [5].

Total thyroidectomy in benign thyroid disease can avoid reoperation in nodular goiter and hyperthyroidism and eliminate any subsequent risk of malignant change in radiated thyroid glands.

A low complication rate can be achieved using meticulous surgical technique. Total thyroidectomy can be performed safely in bilateral benign thyroid disease [6].

Total thyroidecotmy is performed in Graves' disease and toxic multinodular goiter. Surgery seems to be a good alternative to antithyroid agents, which are constraining and often ineffective in the long term [7].

Total thyroidectomy is the treatment of choice in multinodular goiter and thyroiditis, when there is bilateral gland involvement, and in Graves' disease because it decreases the likelihood of future repeated operations for recurrent disease [8].


  Acknowledgements Top


Conflicts of interest

None declared.

 
  References Top

1.Clark OH, Kebebew E. 2005; Text book of endocrine surgery. Vol. 1 Thyroidectomy: Occurence and prevention of complication in thyroid surgery chapter 2nd ed.  Back to cited text no. 1
    
2.Muller, et al. Complications rates after operations for benign thyroid disease. Acta Otolaryngol 2001; 122 :679-683.  Back to cited text no. 2
    
3.Friguglietti CU, Lin CS, Kulcsar MA. Total thyroidectomy for benign thyroid disease. Laryngoscope. 2003 ; 113 :1820-1826.  Back to cited text no. 3
    
4.Lennquist S1, Cahlin C, Smeds S. The superior laryngeal nerve in thyroid surgery. Surgery 1987; 102 :999-1008.  Back to cited text no. 4
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5.Romano G, Luna E, Cocchiara G, et al. The surgical treatment of nodular thyroid lesions: our experince. Analysis of 462 cases. G Chir 2004; 25 :23-26.  Back to cited text no. 5
    
6.Sandonato L, Graceffa G, Cipolla C, et al. Benign diseases of the thyroid: indications for surgical treatment and the current role of total thyroidectomy. Chir Ital 2003; 55 :179-187.  Back to cited text no. 6
    
7.Schüssler F, Chris M, Cristin M Surgical management of Graves′ disease. J Surg Res 2006; 133 :207-214.  Back to cited text no. 7
    
8.Khafif A1, Pivoarov A, Medina JE, Avergel A, Gil Z, Fliss DM. Parathyroid hormone: a sensitive predictor of hypocalcemia following total thyroidectomy. Otolaryngol Head Neck Surg 2006 ;134:907-910.  Back to cited text no. 8
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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  In this article
Abstract
Introduction
Patients and methods
Results
Discussion
Acknowledgements
References
Article Tables

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