Background
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.
Methods
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.
Results
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.
Conclusions
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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Article info
Publication history
Accepted:
July 3,
2007
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
