CHICAGO — Unilateral thyroidectomy is the procedure of choice for symptomatic benign multinodular goiter, Dr. Sarah Olson said at the annual meeting of the Central Surgical Association.
Multinodular goiter is the most common form of benign thyroid disease in the United States and is characterized by symptoms that include dysphagia and shortness of breath. The extent of surgery required—unilateral lobectomy or bilateral resection—is controversial, however, with many surgeons recommending total thyroidectomy for all patients.
“Bilateral surgery should be associated with a lower recurrence rate, but also may have potentially higher morbidity, so we undertook a retrospective analysis of data from an ongoing prospective endocrine database,” said Dr. Olson of the University of Wisconsin, Madison.
Between May 1994 and November 2004, 883 patients underwent thyroid surgery at the university. Of these, 237 patients underwent thyroidectomy for multinodular goiter, with the decision on unilateral or bilateral surgery being at the discretion of the individual surgeon. A total of 140 patients had unilateral lobectomy, with the remaining 97 undergoing total or subtotal thyroidectomy. The patients' mean age was 51 years, and 196 (83%) were female.
With up to 134 months of follow-up, patients who had unilateral resection had an 11% recurrence rate, whereas those in the bilateral group had a recurrence rate of 3%, a statistically significant difference.
The overall postoperative complication rate in the bilateral resection group was significantly higher, at 9%, compared with the unilateral group, at 2%. This difference in complication rate was in large part because of transient hypocalcemia, which was seen in 6% of the bilateral group but in none of the unilateral group, Dr. Olson said.
Of the 18 patients who subsequently required a second procedure for a recurrence of multinodular goiter, there was only one postoperative complication, for a complication rate of 5.5%. “This compares favorably with patients undergoing initial thyroidectomy,” she said.
An audience member, Dr. Christopher R. McHenry of MetroHealth Medical Center, Cleveland, said that “lobectomy is the procedure of choice for symptomatic unilateral multinodular goiter, but only when significant disease is absent in the contralateral lobe.”
Lobectomy is the procedure of choice, but only when significant disease isabsent in the contralateral lobe. DR. MCHENRY