Total thyroidectomy vs subtotal thyroidectomy for plurinodular goiter. Analysis 1517 cases.

Abstract

AIM OF THE STUDY:The surgical treatment of benign thyroid diseases is still controversial, as there is a tendency by some Authors toward a more conservative treatments and wider treatments by others.

OBJECTIVE: To claim and demonstrate that total thyroidectomy is the best and effective surgical therapy in benign thyroid diseases.

MATERIALS AND METHODS: Retrospective study based on an analysis of 2136 patients with benign thyroid diseases of the thyroid, observed from January 1985 to July 2008 in the Operative Unit of Surgical Clinic of the Ospedale Vittorio Emanuele of Catania. Patients with certain or suspected diagnosis of thyroid cancer have been drawn out from the study.

RESULTS: 71% of the patient (that is 1517) were treated for a goiter, 5.9% with preoperative diagnosis of recurrent goiter; 105 cases of primary and non recurrent goiter (6.9%) were found to have foci of microcarcinoma (PTMC) at final histologic examination. All cases of recurrent goiter were selected as non responders patients to suppressive therapy. Total thyroidectomy was performed on 1183 cases (78%), including 89 that required the totalizations for recurrent goiter. The remaining 334 cases with a diagnosis of multinodular goiter were treated with lobectomies or near-total and subtotal thyroidectomy because the remaining parenchima showed macro- and microscopically free of disease. In 1094 cases a total thyroidectomy was performed because extemporary histological examination showed architectural and cytological abnormalities considered as indicative of the formation of new nodules.

CONCLUDING REMARKS: The histological examination carried out on portions of macroscopically healthy thyroid showed almost ubiquitous spread of the disease in the gland, with marks of presumable evolutive disease. Moreover has been also documented the not negligible possibility that residual parenchyma may undergo malignant degeneration. These two last observations justify our inclination toward a radical treatment also of benign thyroid diseases.