Are total thyroidectomy and loboisthmectomy effective and safe in benign thyroid diseases? An analysis of 420 patients

Abstract

Objective. Ideal thyroid surgery is still a debated issue due to preoperative pathology and varying rates of postoperative incidental carcinoma and complications. In our clinic loboisthmectomy and bilateral total thyroidectomy are the treatment of choice in benign nodular thyroid diseases. The objective of this study was to analyse effectiveness and safety of bilateral total thyroidectomy and loboisthmectomy for treating benign thyroid diseases. Methods. Patient charts of the subjects that have undergone thyroid surgery due to benign thyroid diseases between 2009-2015 were evaluated retrospectively. We extracted data including number of patients, type of surgery, preoperative and postoperative pathologies and postoperative complications from departments medical records. Results. Four hundred and twenty patients including 98 (23.3%) male and 322 (76.7%) females aged between 14-80 years (mean; 47.3 ± 12.5) were included into the study. Bilateral total thyroidectomy was performed in 348 (82.9%) patients and loboisthmectomy was performed in 72 (17.1%). Mean duration of follow-up was 41 (range: 15-70) months. Incidental thyroid carcinoma rate was 24.5% (n = 103) in postoperative pathological examination. Temporary and permanent hypocalcemia was seen in 53 (15.2%) patients and 8 (2.3%), respectively. Permanent and transient recurrent laryngeal nerve palsy rate were 2.6% and 2.1%, respectively. Postoperative hematoma was observed in 7 (1.7%) patients. Conclusions. Incidental thyroid carcinoma is frequent in patients who had surgical operation for benign thyroid diseases. When revision surgeries and additional complications due to revision surgery in the remaining cases are kept in mind, bilateral total thyroidectomy or loboisthmectomy at the minimum can be considered as the ideal surgical approach for benign thyroid diseases. 

Keywords

• Benign thyroid disease,multinodular goiter,thyroid surgery,papillary thyroid microcarcinoma,hypoparathyroidism

References

1. [1] Baloch ZW, Cibas ES, Clark DP, Layfield LJ, Ljung BM, Pitman MB, et al. The National Cancer Institute Thyroid fine needle aspiration state of the science conference : a summation. Cytojournal 2008;5:6.
2. [2] Barczyński M, Konturek A, Hubalewska-Dydejczyk A, Gołkowski F, Cichoń S, Nowak W. Five-year follow-up of a randomized clinical trial of total thyroidectomy versus Dunhill operation versus bilateral subtotal thyroidectomy for multinodular nontoxic goiter. World J Surg 2010;34:1203-13.
3. [3] Rayes N, Steinmüller T, Schröder S, Klötzler A, Bertram H, Denecke T, et al. Bilateral subtotal thyroidectomy versus hemithyroidectomy plus subtotal resection (Dunhill procedure) for benign goiter: long-term results of a prospective, randomized study. World J Surg 2013;37:84-90.
4. [4] Slijepcevic N, Zivaljevic V, Marinkovic J, Sipetic S, Diklic A, Paunovic I. Retrospective evaluation of the incidental finding of 403 papillary thyroid microcarcinomas in 2466 patients undergoing thyroid surgery for presumed benign thyroid disease. BMC Cancer 2015;15:330.
5. [5] Miccoli P, Minuto MN, Galleri D, D'Agostino J, Basolo F, Antonangeli L, et al. Incidental thyroid carcinoma in a large series of Consecutive patients operated on for benign thyroid disease. ANZ J Surg 2006;76:123-6.
6. [6] Pappalardo G, Guadalaxara A, Frattaroli FM, Illomei G, Falaschi P. Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports. Eur J Surg 1998;164:501-6.
7. [7] Erbil Y, Barbaros U, Salmaslioğlu A, Yanik BT, Bozbora A, Ozarmağan S. The advantage of near-total thyroidectomy to avoid postoperative hypoparathyroidism in benign multinodular goiter. Langenbecks Arch Surg 2006;391:567-73.
8. [8] Tezelman S, Borucu I, Senyurek GY, Tunca F, Terzioglu T. The change in surgical practice from subtotal to near-total or total thyroidectomy in the treatment of patients with benig nmultinodular goiter. World J Surg 2009;33:400-5.

9. [9] Cibas ES, Ali SZ; NCI Thyroid FNA State of the Science Conference. The Bethesda System For ReportingThyroid Cytopathology. Am J Clin Pathol 2009;132:658-65.
10. [10] Hayward NJ, Grodski S, Yeung M, Johnson WR, Serpell J. Recurrent laryngeal nerve injury in thyroid surgery: a review. ANZ J Surg 2013;83:15-21.
11. [11] Bahl M, Sosa JA, Nelson RC, Esclamado RM, Choudhury KR, Hoang JK. Trends in incidentally identified thyroid cancers over a decade: a retrospective analysis of 2,090 surgical patients. World J Surg 2014;38:1312-7.
12. [12] Luo J, McManus C, Chen H, Sippel RS. Are the repredictors of malignancy in patients with multinodular goiter? J Surg Res 2012;174:207-10.
13. [13] Lasithiotakis K, Grisbolaki E, Koutsomanolis D, Venianaki M, Petrakis I, Vrachassotakis N, et al. Indications for surgery and significance of unrecognized cancer in endemic multinodular goiter. World J Surg 2012;36:1286-92.
14. [14] Carlini M, Giovannini C, Castaldi F, Mercadante E, Dell'Avanzato R, Zazza S, et al. High risk for microcarcinoma in thyroid benign diseases. Incidence in a one year period of total thyroidectomies. J Exp Clin Cancer Res 2005;24:231-6.
15. [15] Nilakantan A, Venkatesh M.D, Raghavan D, Datta R, Sharma V. Ultrasonography: its role in nodular thyroid disease. Indian J Otolaryngol Head Neck Surg 2007;59:332-5.
16. [16] Teixeira GV, Chikota H, Teixeira T, Manfro G, Pai SI, Tufano RP. Incidence of malignancy in thyroid nodules determined to be follicular lesions of undetermined significance on fine-needle aspiration. World J Surg 2012;36:69-74.
17. [17] Sakorafas GH, Giotakis J, Stafyla V. Papillary thyroid microcarcinoma: a surgical perspective. Cancer Treat Rev 2005;31:423-38.
18. [18] Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016;26:1-133.
19. [19] Müller PE, Kabus S, Robens E, Spelsberg F. Indications, risks, and acceptance of total thyroidectomy for multinodular benign goiter. Surg Today 2001;31:958-62.
20. [20] Robert J, Mariéthoz S, Pache JC, Bertin D, Caulfield A, Murith N, et al. Short- and long-term results of total vs subtotal thyroidectomies in the surgical treatment of Graves' disease. Swiss Surg 2001;7:20-4.
21. [21] Dener C. Complication rates after operations for benign thyroid disease. Acta Otolaryngol 2002;122:679-83.
22. [22] Pelizzo MR, Toniato A, Piotto A, Bernante P, Pagetta C, Bernardi C. Prevention and treatment of intra- and post-operative complications in thyroid surgery. Ann Ital Chir 2001;72:273-6.
23. [23] Aytac B, Karamercan A. Recurrent laryngeal nerve injury and preservation in thyroidectomy. Saudi Med J 2005;26:1746-9.
24. [24] Osmólski A, Frenkiel Z, Osmólski R. Complications in surgical treatment of thyroid diseases. Otolaryngol Pol 2006;60:165-70.
25. [25] Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, Pelizzo MR, et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 2004;28:271-6.
26. [26] Delbridge L, Guinea AI, Reeve TS. Total thyroidectomy for bilateral benign multinodular goiter: effect of changing practice. Arch Surg 1999;134:1389-93.
27. [27] Bergenfelz A, Jansson S, Kristoffersson A, Mårtensson H, Reihnér E, Wallin G, et al. Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg 2008;393:667-73.
28. [28] Cohen-Kerem R, Schachter P, Sheinfeld M, Baron E, Cohen O. Multinodular goiter: the surgical procedure of choice. Otolaryngol Head Neck Surg 2000;122:848-50.
29. [29] Karakoyun R, Bülbüller N, Koçak S, Habibi M, Gündüz U, Erol B, et al. What do we leave behind after neartotal and subtotal thyroidectomy: just the tissue or th edisease? Int J Clin Exp Med 2013 25;6:922-9.
30. [30] Giles Y, Boztepe H, Terzioglu T, Tezelman S. The advantage of total thyroidectomy to avoid reoperation for incidental thyroid cancer in multinodular goiter. Arch Surg 2004;139:179-82.
31. [31] Vaiman M, Nagibin A, Olevson J. Complications in primary and completed thyroidectomy. Surg Today 2010;40:114-8.