The efficacy and safety of total thyroidectomy in the management of benign thyroid diseases

Background: Total thyroidectomy is currently  the preferred  treatment for thyroid cancer, multinodular goitre and Graves disease,· however, many surgeons choose not to perform total thyroidectomy to treat benign thyroid diseases owing to the associated  risk of postoperative hypoparathyroidism and recurrent laryngeal nerve damage. We followed up 100 thyroidectomies performed for benign thyroid diseases when surgery was indicated. We sought to assess whether the results  support  the hypothesis that total thyroidectomy is as safe and more effective  as subtotal thyroidectomy and can be considered  as the optimal surgical approach for treating benign thyroid diseases. Methods: A total of 100 patients underwent thyroidectomy between January 2008 and June 2009. We excluded patients with thyroid cancer or suspicion of thyroid malignancy. We evaluated operative time, intraoperative blood loss, cancer incidence, complication rates, local recurrence rate and long-term outcome after total and subtotal thyroidectomy. Results: All patients were diagnosed before surgery to have benign thyroid disease by fine needle aspirate. The incidence  of permanent  recurrent  laryngeal nerve palsy  (unilateral or bilateral) was 0% in both groups, whereas  the incidence of temporary unilateral recurrent laryngeal  nerve  palsy was 4% in cases of total thyroidectomy and 2% in cases  of subtotal thyroidectomy. Permanent hypocalcemia occurred in 2% in each group and overall temporary hypocalcemia occurred in 10% ofpatients with total thyroidectomy and 8% ofpatients with subtotal thyroidectomy. Hemorrhage requiring repeat surgery occurred in 2% of patients with total thyroidectomy and 4% of patients  with subtotal  thyroidectomy. There  was no wound infection, and postoperative mortality was 0%. Incidental finding of cancer appeared in 8% of patients with total thyroidectomy and 18% of patients with subtotal thyroidectomy. We observed no disease recurrence  during a follow-up of 18 months in patients with total thyroidectomy, while a high rate of recurrence (8%) appeared in patients with subtotal thyroidectomy in the same follow-up period. Conclusion: Total thyroidectomy is safe and is associated with a low incidence of disabilities. Complication rates for recurrent laryngeal nerve palsy and hypoparathyroidism are approximately similar to results of those with subtotal thyroidectomy. Furthermore, total thyroidectomy seems to be the optimal procedure, when surgery is indicated, for benign thyroid diseases as it has the advantages of immediate and permanent cure and no recurrences and higher rate of detection of occult cancer.