Total or Subtotal Thyroidectomy in the Management of Multinodular Goiter

Background: For a long time, subtotal thyroidectomy was considered the standard surgical approach for multinodular goiter; however this concept started to change in favour of total thyroidectomy. Many issues have been involved in that argument before rendering one operation superior to the other. This work was conducted to compare between the two operations in terms of occurrence of postoperative morbidity and the functional outcome. Patients & methods: A total number of 106 patients with multinodular goiter were managed surgically in Gazan General Hospital. A group of 57 patients who underwnt subtotal thyroidectomy were compared with 49 patients who underwent total thyroidectomy. The obtained data included patient demographics, operation type, pathology, hospital stay and postoperative early and late complications such as recurrent laryngeal nerve palsy, parathyroid gland affection, wound infection, haematoma, reoperation for haemorrhage, and death. Results: There was no significant difference in the sex, age, duration of goiter or hormonal status between the two groups (P =0.64, P =0.73, P =0.59 and P=0.73, respectively). The compression symptoms and recent enlargement of the gland represented the two main indications for surgery in both groups. The mean operating time and the mean hospital stay was shorter in the subtotal group when compared with the total group but this was not statistically significant (P >0.05). The difference in the incidence of transient and permanent nerve palsy between the two groups was not statistically significant (P >0.05). The incidence of postoperative temporary hypocalcaemia was significantly higher in total thyroidectomy group (P =0.02) while the incidence of permanent hypocalcaemia was not statistically significant between the two groups (P >0.05). Conculsion: The rate of permanent complications with total thyroidectomy is not greater than that of subtotal thyroidectomy so, it can be performed safely and should be recommended as the procedure of choice for patients requiring surgical treatment for multinodular goiter