Rationale for near total thyroidectomy in patients with multinodular goitre

ABSTRACT

To prove that Near total Thyroidectomy [NTT] with minimal residual tissue is the procedure of choice in patients with Multi-Nodular Goitre [MNG]. Retrospective study from February 2002 to December 2006. Surgical Ward-II, Jinnah Postgraduate Medical Centre [JPMC], Karachi. A total of 521 consecutive patients, operated for simple or toxic MNG were included in this study. Apart from detailed clinical work-up, investigations including thyroid function tests and thyroid scans were carried out in all cases. All patients underwent near total thyroidectomy with preservation of recurrent laryngeal nerves and parathyroid glands. Out of 521 cases, 73 [14%] had carcinoma on histopathological examination of the removed glands; 47 [64%] underwent completion thyroidectomy which was uneventful, while 22 had radioiodine ablation with decreased dosage for provision of minimal residual tissue and four declined further treatment. Near total thyroidectomy is a versatile surgical procedure for patients with MNG, keeping in view the risk of associated occult malignancy. Furthermore, the risk of damage to recurrent laryngeal nerve [RLN] and parathyroids is low in patients undergoing completion thyroidectomy. Hence, a more radical procedure should be adopted for surgical treatment in MNG