Total thyroidectomy for bilateral benign thyroid disease: safety profile and therapeutic efficacy

Multinodular goiter (MNG) is the most common indication for thyroidectomy in endemic iodine-deficiency regions.Objective: To analyze the safety and effectiveness of total thyroidectomy in the surgical management of bilateral multinodular goiter Design: Retrospective S e t t i n g : King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia Patients and Methods: The medical re c o rds of all patients who underwent total thyroidectomy over a fiveyear period (August 2000 through July 2005) at King Khalid University Hospital, Riyadh, KSA, were examined. The data regarding age, sex, indication for surgery, histological diagnosis, and complications, if any was extracted from the files. Results: There were a total of 164 patients (113 female and 51 male). Their age ranged from 18 - 63 years with a mean of 40 ± 11.0 years. Seventy six (46.3%) cases p resented with compressive and 29 (17.6%) with thyrotoxic symptoms; 24 (14.6%) for cosmetic reasons, 18 (10.9%) for suspected malignancy and 3 (1.8%) with retrosternal extension. Multinodular goiter was the most f requent histological finding (reported in 88, 51.8% patients) followed by colloid goiter in 22 (13.4%) cases. Incidental thyroid malignancy was recorded in 13 (8%) subjects, (five papillary and six follicular carcinomas, one lymphoma and one follicular variant of papillary carcinoma). Permanent recurrent laryngeal nerve (RLN) palsy and permanent hypoparathyroidism occurred in one (0.6%) and five (3%) patients respectively. There was no mortality. Conclusion: Total thyroidectomy is a safe alternative for patients with bilateral multinodular goiter. This procedure has low complication rate and eliminates the need for re-operation for recurrent goiter and unexpected thyroid malignancy