Surgical treatment of Hashimoto's thyroiditis. Personal experience

BACKGROUND: To report personal experience in the surgical treatment of Hashimoto's thyroiditis. METHODS. Eight patients (7 females, 1 male, mean age 48 years old) referred to our Institution with diagnosis of Hashimoto's thyroiditis have been studied. All patients were evaluated by determination of serum thyroid hormones and of anti-thyreoglobulin and anti-microsomal antibodies; ultrasound and scintigraphic scans of the gland were performed in all cases and a cytological examination of fine needle aspiration (FNAC) of the nodules was evaluated. Diagnosis of Hashimoto's thyroiditis was suspected on the basis of clinical and laboratory data and was confirmed by cytology and histology on surgical specimens. Preoperative FNAC showed a Hashimoto's thyroiditis with thyroid differentiated carcinoma in 3 cases (37.5%), Hashimoto's thyroiditis in 1 case and chronic thyroiditis in 4 cases (50%). Seven patients underwent surgery, while 1 patient received a medical treatment; we performed 6 total thyroidectomies and 1 hemithyroidectomy. Histology on surgical specimens confirmed the diagnosis of Hashimoto's thyroiditis in all cases; in 3 patients an associated papillary thyroid carcinoma was found. RESULTS: Postoperative mortality was absent; no major postoperative complications (laryngeal nerve paralysis or permanent hypocalcemia) were recorded. Only 2 mild transient hypocalcemias have been observed. CONCLUSIONS: Total thyroidectomy is the technique of choice in surgical treatment of Hashimoto's thyroiditis, a self-immune pathology which involves the whole gland and has a high correlation with differentiated thyroid carcinoma (37.5%). Total thyroidectomy warrants a radical and definitive control of the disease, without risk of relapse, with a low incidence of major complications, in experienced hands, and anyway lower than the morbility due to reinterventions