TOTAL THYROIDECTOMY FOR BENIGN THYROID-DISEASE

Background. The goal of this study was to evaluate the safety and effi cacy of total thyroidectomy performed for benign thyroid disease. Meth ods. A total of 106 consecutive patients undergoing total thyroidectom y for benign disease from October 1982 to July 1995 were reviewed. The 33 men and 73 women had an average age of 46 years (range, 16 to 82 y ears). Indications for total thyroidectomy were a thyroid nodule with the history of head and neck radiation in 36 patients, bilateral thyro id nodules in 35, needle biopsy of a follicular neoplasm or frozen sec tion diagnosis of a possible malignancy in 18, and toxic goiter in 17. Total thyroidectomy was performed as the primary operation in 98 Pati ents, and 8 Patients had a completion reoperation for recurrent diseas e. Results. Pathology findings revealed benign nodular goiter in 49 pa tients, follicular adenoma in 26, hyperplasia in 19, and Hashimoto's t hyroiditis in 12. Postoperative hemorrhage requiring operative hemosta sis occurred in two patients (1.9%). Two patients had unilateral recur rent laryngeal nerve (RLN) palsy before operation (1.9%). Three patien ts had unilateral postoperative RLN palsy (2.8%). Two cases resolved i n 3 and 4 months. The only permanent RLN injury occurred in a patient reoperated for a compressive goiter. Early postoperative hypocalcemia (8.0 mg/dl or less) was found in nine patients (8.5%). No patient had permanent hypoparathyroidism at long-term follow-up evaluation. Conclu sions. Total thyroidectomy for benign thyroid disease can avoid reoper ation for nodular goiter and hyperthyroidism and eliminate any subsequ ent risk of malignant change in radiated thyroid glands. A low complic ation rate can be achieved with meticulous surgical technique. Total t hyroidectomy can be performed safely for bilateral benign thyroid dise ase.