Central Surgical Association| Volume 142, ISSUE 4, P458-462, October 2007

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Symptomatic benign multinodular goiter: Unilateral or bilateral thyroidectomy?


      Symptomatic benign multinodular goiter (MNG) is extremely common in the north central United States. The extent of surgery for unilateral or bilateral disease is controversial. Bilateral resection should be associated with low recurrence rates, but potentially a higher technical morbidity. The long-term outcomes of patients with obvious unilateral MNG who had unilateral resection only is not commonly reported. To determine the optimal operation for patients with symptomatic MNG, we reviewed our single institutional results.


      From May 1994 through November 2004, 883 patients underwent a thyroid operation at our institution. Of these, 237 (27%) underwent thyroidectomy for MNG. One hundred forty patients underwent unilateral lobectomy and 97 underwent total thyroidectomy.


      The mean age was 51 ± 1 years and 196 (83%) were female. With up to 145 months’ follow-up, there was a higher recurrence rate in the lobectomy group (11% vs 3%; P = .029). However, patients in the lobectomy group had a much lower complication rate (2% vs 9%; P = .007). Importantly, in patients who underwent reoperation for recurrent MNG after lobectomy, the complication rate was low (5.5%) and not significantly higher than the initial surgery.


      In patients with symptomatic MNG, 89% of those who underwent unilateral resection did not require further surgery. Unilateral thyroidectomy was associated with lower morbidity than bilateral resection. Furthermore, those patients who required operation for contralateral recurrence did not experience a significantly higher operative morbidity. Therefore, these data convincingly support recommending unilateral thyroid lobectomy as the procedure of choice for patients with symptomatic unilateral MNG.
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        • Chen H.
        • Dudley N.E.
        • Westra W.H.
        • Sadler G.P.
        • Udelsman R.
        Utilization of fine-needle aspiration in patients undergoing thyroidectomy at two academic centers across the Atlantic.
        World J Surg. 2003; 27: 208-211
        • Lang B.H.H.
        • Lo C.Y.
        Total thyroidectomy for multinodular goiter in the elderly.
        Am J Surg. 2005; 190: 418-423
        • Liu Q.
        • Djuricin G.
        • Prinz R.A.
        Total thyroidectomy for benign thyroid disease.
        Surgery. 1998; 123: 2-7
        • Greenblatt D.Y.
        • Woltman T.
        • Harter J.
        • Starling J.
        • Mack E.
        • Chen H.
        Fine-needle aspiration optimizes surgical management in patients with thyroid cancer.
        Ann Surg Oncol. 2006; 13: 859-863
        • Rios A.
        • Rodriguez J.M.
        • Balsalobre M.D.
        • Torregrosa N.M.
        • Tebar F.J.
        • Parrilla P.
        Results of surgery for toxic multinodular goiter.
        Surg Today. 2005; 35: 901-906
        • Shaha A.R.
        • Raffaelli
        • Proye C.
        • Haigh P.I.
        • Prinz R.A.
        • Dejong S.A.
        Predictive factors for recurrence after thyroid lobectomy for unilateral nontoxic goiter in an endemic area: results of a multivariate analysis—discussion.
        Surgery. 2004; 136: 1250-1251
        • Sippel R.S.
        • Ozgul O.
        • Hartig G.
        • Mack E.
        • Chen H.
        The risks and consequences of incidental parathyroidectomy during thyroid resection.
        Aust N Z J Surg. 2007; 77: 33-36
        • Prinz R.A.
        • Rossi H.L.
        • Kim A.W.
        Difficult problems in thyroid surgery.
        Curr Probl Surg. 2002; 39: 5
        • Thomusch O.
        • Sekulla C.
        • Dralle H.
        Is primary total thyroidectomy justified in benign multinodular goiter?.
        Chirurg. 2003; 74: 437-443
        • McHenry C.R.
        • Piotrowski J.J.
        Thyroidectomy in patients with marked thyroid enlargement—airway management, morbidity, and outcome.
        Am Surg. 1994; 60: 586-591
        • Phitayakorn R.
        • Super D.M.
        • McHenry C.R.
        An investigation of epidemiologic factors associated with large nodular goiter.
        J Surg Res. 2006; 133: 16-21
        • Sippel R.S.
        • Chen H.
        Reoperative Endocrine Surgery.
        in: Callery M. Handbook of reoperative general surgery. Blackwell, Maiden, Mass2006: 135-150
        • Chen H.
        Voice changes after thyroid surgery: how often do they occur and can they be prevented?.
        Contemp Surg. 2006; 62: 410-413
        • Wilson D.B.
        • Staren E.D.
        • Prinz R.A.
        Thyroid reoperations: indications and risks.
        Am Surg. 1998; 64: 674-678
        • Lo C.Y.
        • Kwok K.F.
        • Yuen P.W.
        A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy.
        Arch Surg. 2000; 135: 204-207
        • Zambudio A.R.
        • Gonzalez J.M.R.
        • Perez N.M.T.
        • Madrona A.P.
        • Jordana M.C.
        • Paricio P.P.
        Hypoparathyroidism and hypocalcemia following thyroid surgery by multinodular goiter.
        Med Clin. 2004; 122: 365-368
        • Gibelin H.
        • Sierra M.
        • Mothes D.
        • Ingrand P.
        • Levillain P.
        • Jones C.
        • et al.
        Risk factors for recurrent nodular Goiter after thyroidectomy for benign disease: case-control study of 244 patients.
        World J Surg. 2004; 28: 1079-1082
        • Ozbas S.
        • Kocak S.
        • Aydintug S.
        • Cakmak A.
        • Demirkiran M.A.
        • Wishart G.C.
        Comparison of the complications of subtotal, near total and total thyroidectomy in the surgical management of multinodular goitre.
        Endocr J. 2005; 52: 199-205
        • Schussler-Fiorenza C.M.
        • Bruns C.M.
        • Chen H.
        The surgical management of Graves’ disease.
        J Surg Res. 2006; 133: 207-214
        • Hedayati N.
        • McHenry C.R.
        The clinical presentation and operative management of nodular and diffuse substernal thyroid disease.
        Am Surg. 2002; 68: 245-251