RISK-FACTORS OF NODULAR RECURRENCE AFTER THYROIDECTOMY FOR SIMPLE GOITER

We report a retrospective series of 44 recurrences of nodular goitre f ollowing 430 partial thyroidectomies over a 10 years period There were 40 women and 4 men with a mean age of 43 and 3 7 years respectively. Twenty-four recurrences were from our institution (6%) and 20 were ref erred to us. The median follow-up of primary thyroidectomies was 8,5 y ears for patients with recurrence and 4 years for patients free of rec urrence (p < 10(-6)). The incidence of recurrence was analysed in a st atistical and acturial model considering clinical intra-operative and post-operative variables. The following risk-factors for recurrence we re found: age < 50 years (p < 0,01), family history of goitre (p < 0,0 4), unilateral multinodularity (p < 0,0002), diffuse and bilateral dis tribution of nodules (p < 0,02), atypical resections with conservation of isthmus (p < 0,0001), scintigraphically <<warm>> nodules (p < 0,00 1). Interestingly, sex, heterogenous thyroid parenchyma without macros copic nodules and the use of post-operative levothyroxine did not modi fy the risk of recurrence. Thity-three patients were non symptomatic. Thirty-four patients underwent re-operation. Three primary non suspect ed carcinomas were found There was no mortality related to re-operatio n. There were not definitive vocal cord paralysis or hypocalcemia. The re was no significant difference in vocal or parathyroid morbidity whe n total thyroidectomy for primitive goitre was compared to total thyro idectomy as re-operation. Long-term and periodic follow-up is necessar y to delect non-symptomatic recurrences in a high-risk population. Tot al thyroidecotmy is the treatment of choice for bilateral multinodular goitre. When a recurrence is diagnosed, re-operation must be consider ed, especially if a non-occult carcinoma of the thyroid remnant cannot be formally excluded.