Trend in Surgical Management for Thyroid Diseases

ABSTRACT

PURPOSE: Thyroid disease is the most common form of endocrinologic disease. Despite recent advances in diagnosis, controversy still remains concerning the surgical management of thyroid disease. The aim of this study was to analyze the clinical distribution and the inclination of surgical treatment for thyroid disease. METHODS: The medical records from 1,743 patients who had undergone thyroid resections for thyroid diseases between January 1989 and December 1998 at Kwangju Christian Hospital were reviewed retrospectively. RESULTS: Of the 1,743 patients with thyroid diseases, 1,285 had benign diseases and 458 had carcinomas, resulting in a 26.3% prevalence of malignancy. Female patients were predominate, being 6.89 times the number of males. The peak incidence of age was the 4th decade for patients with benign diseases (29.4%) and the 5th decade for those with malignant diseases (26.0%). Both benign (39.4%) and malignant diseases (42.1%) were more prevalent on the right lobe. The incidence of carcinomas was 28.9% in solitary nodules and 29.3% in multinodular goiters. In the histopathologic study, the most common type was a papillary carcinoma (84.5%) in malignancies and an adenomatous goiter (48.8%) in benign diseases. The most commonly performed surgical procedures were a total thyroidectomy (75.4%) for malignancies and a lobectomy for benign diseases (63.3%). Postoperative complications were 3.1% in patients with benign diseases and 29.7% in those with malignancies. Regional recurrence or distant metastases appeared in 5.5% of the patients during the 10 years following treatment. CONCLUSION: The treatments of choice were a thyroid lobectomy for patients with benign diseases and a total thyroidectomy for those with malignant diseases. However, the decision to perform a surgical resection should be based on the age and the general condition of patient.