Comparison complication and outcomes of subtotal thyroidectomy versus total thyroidectomy in 504 patient with multinodular goiter
Background
Surgery is one of the methods for the management of Multinodular Goiter (MNG), which perform with Subtotal Thyroidectomy (ST.T) or Total Thyroidectomy (T.T) method. Nowadays ST.T is better method, but some surgeons tends to use T.T for MNG and choices of surgical method in MNG is controversial yet. Surgeons who select ST.T, advocate this method because of reducing damage from surgery, maintaining healthy thyroid tissue and thyroid function. On the other hand, surgeons who select T.T advocate it because of MNG recurrence, casual cancer incidence and incidence risk of malignancy in thyroid remnant which need for further surgery and increase complications. In this study, we compared the rate of complications, clinical findings, laboratory and pathological results of patients in both groups.
Material and methods
Our target population in this study was the total population that refer to Baqiyatallah hospital and Erfan hospital for thyroid surgery in 2012-2014 which was 728. 504 subjects of this number were participated in study based on clinical history, FNA and sonographic finding with MNG diagnosis. 224 subjects were excluded from study based on FNA with any diagnosis except MNG, sonography with suspect result of malignancies, family history of thyroid cancer or receiving radiation. 227 subject of this number, were classified in ST.T group and 277 subject in T.T group. Results were analyzed with SPSS 20, z-test and t- test CHI square.
Results
The study was conducted in two groups according to demographic, clinical and paraclinical factors. There was no significant difference, except in nodule number ≥6 which was 58% and 35% in T.T and ST.T group, respectively (p<0.001). Also, there was no significant difference about surgery complications, need for blood transfusion and final pathological test. We observe a significant difference about duration of surgery and hospitalization time, which was 2.6 and 2.2 in T.T and ST.T group, respectively) p<0.001( and 126 minutes and 108 minutes in T.T and ST.T group, respectively (p<0.001). In this study we use all options for choosing MNG patients such as clinical history, family history, sonography and FNA. But finally, 3.2% casual cancer and 5.2% cases which need T.T surgery were reported in both group.
Conclusion
According to the significant difference in the incidence of surgical complications between the two methods and given the prevalence of casual cancer and other cancers which need again surgery and due to the increasing levels of thyroid surgery complications, T.T is the best method.