NODULAR GOITER - A RETROSPECTIVE ANALYSIS OF 608 CASES

A retrospective study was carried out on a series of 608 patients, of whom 430 had undergone partial and 178 total thyroidectomy for single or multinodular goitre. Statistical analysis of data for the 532 women (88%) and 76 men (12%), mean age 45 and 39 years respectively, includ ed clinical and operative features, specific morbidity of the exeresis , incidence of cancer on multinodulr goitre and the frequency of recur rence of nodular lesions. The men were significantly younger at time o f diagnosis (p < 0.0006). Bilateral multinodular forms (n = 577) and h ypofixing lesions (n = 515) predominated The incidence of unsuspected thyroid cancer in the multinodular cases was 3% (15/444). Carcinoma de velopment on single nodules in our series during the same period was 8 % (n = 15/195), the difference being statistically significant (p < 0. 02). Mortality was nil and non specific morbidity 2% (n = 12/608). No compressive hematoma was reported and tracheotomy was never required A clinically detectable alteration in the voice was noted in 10% (n = 6 7/608), this persisting in 0.5% (n = 3) beyond the 6th postoperative m onth. No significant difference existed between general and vocal morb idity as a function of the type of exeresis. Hypocalcemia was observed in 11% of patients (n = 67/608), 49% (n = 33/67) being asymptomatic a nd the anomaly spontaneously reversible. Four percent (n = 7/178) were permanent after total thyroidectomy (including 15 cancers on multinod ular goitre discovered fortuitously, 8 of which received lymph node di ssection) and 3% (n = 2168) after a <<wide>> subtotal thyroidectomy. D ifferences between percentage incidence of chronic and transient hypoc alcemia after <<wide>> subtotal and total thyroidectomy were not stati stically significant. At 4 year follow up of our series, nodular recur rence rate after partial interventions was 6% (n = 241430), actuarial analysis of recurrence demonstrated the presence of a high risk popula tion. Lobular or total anatomic resections can be adjusted as a functi on of macroscopic extension of lesions, with an acceptable morbidity a nd a reduced risk of recurrence.