|Year : 2014 | Volume
| Issue : 1 | Page : 205-207
Evaluation of total thyroidectomy in benign thyroid diseases
Hatem Mahmoud Sultan, Hossam Abd El-Kader Ahmed, Hany Ibrahim Sedhom
Department of Surgery, Faculty of Medicine, Menoufia University, Menoufia, Egypt
|Date of Submission||12-May-2013|
|Date of Acceptance||29-Jul-2013|
|Date of Web Publication||20-May-2014|
Hany Ibrahim Sedhom
Department of Surgery, Faculty of Medicine, Menoufia University, Fisha El kobra, Menoufia
Source of Support: None, Conflict of Interest: None
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).
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.
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.
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
| Introduction|| |
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 .
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 .
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 .
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 .
| Patients and methods|| |
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.
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 . 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|| |
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.
| Discussion|| |
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 .
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 .
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 .
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 .
| Acknowledgements|| |
Conflicts of interest
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[Table 1], [Table 2], [Table 3], [Table 4]