THYROID-GLAND SURGERY IN AN ENDEMIC REGION

To assess the incidence, indications, and complications of (reoperativ e) thyroid gland surgery in an endemic region, we have retrospectively analyzed 1318 patients operated on between 1983 and 1994, There were 166 reoperations (13.5%). fn comparison to the primary operation the i ndication for reoperation showed an increased rate of premalignant and malignant tumors (+16%) and a decreased rate of hyperthyroid disorder s (-30%). The largest group operated on had benign multinodular goiter s, with the same rate of indication for primary (57.4%) and secondary (57.8%) surgery, Permanent recurrent laryngeal nerve palsy rate follow ing primary operation occurred at rates of 1.7% (1983-1990) and 0.7% ( 1991-1993) and for secondary operation 3.5% (1983-1990) and 5.6% (1991 -1994), respectively. The change in recurrent nerve palsy rate in the later years was due to a more extensive resection policy at the primar y operation and a more liberal approach to reoperative surgery. The hi gh rate of reoperation for benign goiters (13%) and the new data of go itrogenesis have therefore directed our policy to more extensive resec tion of the thyroid tissue at the initial operation, increasing the ra te of lobectomy from 27% (1982-1990) to > 90% (1991-1994) and at the s ame time lowering morbidity, Extensive resection of nodular tissue dur ing the initial operation safely reduces the incidence of recurrent go iter and subsequently reduces the rate of reoperation and eliminates t he high risk of morbidity associated with reoperative thyroid surgery. The indications for reoperation should be strict, and when unavoidabl e a modified lateral approach may be helpful.