TOTAL COMPARED WITH SUBTOTAL THYROIDECTOMY IN BENIGN NODULAR DISEASE - PERSONAL SERIES AND REVIEW OF PUBLISHED REPORTS

Objective: To evaluate the outcome after total and subtotal thyroidect omy for the treatment of single and multinodular goitres in two compar able groups of patients. Design: Prospective randomised study. Setting : University hospital, Italy. Subjects: 141 Patients operated on for b enign goitre from 1975-85. Interventions: 69 Patients were randomised to have total thyroidectomy and 72 subtotal thyroidectomy by standard techniques. Main outcome measures: Temporary or permanent palsy of the recurrent laryngeal nerve, temporary or permanent hypoparathyroidism, recurrence of the goitre, and the incidence of iatrogenic injuries af ter completion thyroidectomy. Results: Patients were followed up for a median of 14.5 years (range 10-21). After total thyroidectomy 2 patie nts (3%) developed temporary palsy of the recurrent laryngeal nerve bu t there were no permanent lesions; and 24 (35%) developed temporary an d 2 (3%) permanent hypoparathyroidism. After subtotal thyroidectomy 2 (3%) developed temporary and 1 (1%) permanent palsy of the recurrent l aryngeal nerve; and 13 (18%) developed temporary and 1 (1%) permanent hypoparathyroidism. In addition, there were IO recurrent goitres (14%) . After completion thyroidectomy (n = 9) there were 2 cases of tempora ry and 1 of permanent palsy of the recurrent laryngeal nerve, and 2 ca ses of temporary and 2 of permanent hypoparathyroidism. Conclusion: To tal thyroidectomy is the procedure of choice for the treatment of beni gn nodular goitre.