Total thyroidectomy in benign disease of the thyroid

Abstract

INTRODUCTION: Total thyroidectomy (TT) is a new concept in management of benign diseases of the thyroid (BDT). Many surgeons are reluctant to perform TT for BDT due to the presumed risk of recurrent laryngeal nerve (RLN) damage and hypo parathyroid ism. Subtotal thyroidectomy is associated with a higher rate of recurrence and surgery for recurrent goiter has a significantly high rate of RLN damage and hypoparathyroidisrn. The current world trend favours TT for BDT. However, there is very little data on TT for BDT in Sri Lanka. PATIENTS AND METHODS: Epidemiological data, data on thyroid illness and postoperative complications of 22 consecutive patients who underwent TT for BDT between May 2001 and Aug 2004 were recorded in a standardized proforma. RESULTS: The median age was 46.5 (range 27 - 64) years. There were 20 females and 2 males. Nine patients had toxic nodular goiters, 9 had euthyroid nodular goiters while 4 had diffuse toxic goiters. Postoperative vocal cord examination which was performed during extubation, revealed normal vocal cord function in all patients. However 8 (36.5%) patients complained of transient hoarseness of voice and 3 (13.5%) patients developed transient hypoparathyroidisrn. All these symptoms resolved within 2 months of surgery. There were no recurrences duringa mean follow-up of 15.2 months. One patient's histology revealed an incidental folltcular carcinoma. CONCLUSIONS: TT thyroidectomy is safe with a low incidence of complications. It has several advantages including dealing with occult malignancies and preventing recurrence.