Long-term results of selective thyroid surgery for benign nodular goiter (BNG)
Panagiotis Fikatas, Babette Koch, Christian Vorländer & Robert A Wahl
Background: Total thyroidectomy is postulated by many centers as the standard procedure in treatment of benign nodular goiter (BNG) to avoid recurrent goiter (reported 30% and more). In our hospital a wide spectrum of methods regarding extent of resection is performed, adapted to morphology and respecting function.
We advocate a variable strategy of operations for BNG (selective thyroid surgery, KOCHER 1917) and report on long-term results.
Patients/methods: In 2009, we performed a reinvestigation of patients operated due to BNG in 1997(n=261).
Focus of our interest were permanent complication rates and recurrence of goiter.
Besides clinical examination, we performed ultrasound (10 000 MHz) and determined TSH, T3, T4. Additional diagnostics were performed when necessary. A total of 111 patients were reevaluated.
Recurrence was defined by any stage of goiter, circumscript lesions of more than 10 mm of diameter, over-norm thyroid volume and any non-facticious hyperthyroidism.
Results: RLN paralysis was permanent in 1 (0.9%), hypocalcemia in 1 (0.9%) patient.
One palpable node found in a non resected lobe.
Sonographically, besides this node, one lesion of 12 mm was detected in a selectively resected lobe.
Three patients showed over-norm volumes in lobes after contralateral lobectomy (compensatory enlargement, 2.7%).
No hyperthyroidism was present.
In another 10 patients small lesions (210 mm) were detected.
Thus, by definition, recurrence occured in two patients (1.8%), one of them is a pseudorecurrence.
Conclusions: Strategy of selective surgery bears a low risk of complications as well as a low risk of recurrence.
We enforce this strategy which is both radical and preserving function.
There is no necessity to claim total thyroidectomy as the standard procedure.
Although substitution with thyroxine is seemingly unproblematic (depending also on socioeconomic conditions), we are fully convinced that it is unjustified to make numbers of patients completely drug-dependant without any necessity.