The Causes of Formation and the Surgical Treatment of Recurrent Goiter

Abstract Background. Recurrent goiter is the regrowth of thyroid tissue after strumectomy. Its causes include the strategy of surgical treatment and the kind of substitution therapy after operation. Objectives. The aim of this study was to analyze the causes of recurrent goiter formation. Material and Methods. Fifty−six patients with recurrent goiter were operated on in 1991-2000. In accordance with the procedures and terminology of the Bayes methods for data analysis, three types of statistical model were used: the binomial−beta hierarchical model, the Cox proportional hazard model, and the Weibull regression model. Significant results are reported. Results. In the patients who received substitution therapy after the primary operation, the percentage of recurrences was one sixth of that of the group who received no substitution therapy. Recurrence was faster in patients who were older at the time of the primary operation. The risk of recurrence increased with time after the primary operation. The percentage of true recurrent goiter in this material was 73% and pseudo−recurrent 27%. Pseudo−recurrence was mostly in a non−operated lobe (67%), rarely in the pyramidal lobe (20%) and isthmus (13%). The mean time of true recurrence was 19 and of pseudo−recurrence 11 years. Conclusions. Because of the high percentage of pseudo−recurrences after strumectomy and the short time of their formation, the primary operation should be based on pyramidal lobe removal and be bilateral and sufficiently com− plete, with excision of both lobes. Postoperative substitution therapy reduces the rate of goiter recurrence. The pri− mary operation for goiter should be performed promptly after its diagnosis because recurrence is faster in older people. After the primary operation the patients should be monitored for several years to diagnose recurrence as early as possible (Adv Clin Exp Med 2009, 18, 6, 595-599)