Objective: To find out which procedure was the safest for each indication f
or operation in diseases of the thyroid gland.
Design: Retrospective study.
Setting: Two teaching hospitals, The Netherlands.
Subjects: 599 consecutive patients who had 601 thyroid operations between 1
October 1985 and 1 June 1993.
Main outcome measures: Incidence of complications, particularly postoperati
ve hypocalcaemia and injuries to the recurrent laryngeal nerve.
Results: Accidental injuries to the recurrent laryngeal nerve occurred in 0
.7% of the nerves at risk (7/948) and the incidence of permanent hypocalcae
mia was 5.2% (31/599). In subtotal procedures (bilateral subtotal thyroidec
tomy with the remnant left dorsally or total hemithyroidectomy combined wit
h subtotal hemithyroidectomy on the other side with a remnant left at the u
pper pole) the rate was 11/390 (2.8%) compared with 18/525 (3.4%) after tot
al resections. The corresponding numbers of accidental injuries to the recu
rrent laryngeal nerve were 2 and 4.
Conclusions: Total thyroidectomies are more likely to be done for malignant
disease, so the slightly higher complication rates probably reflect the na
ture of the disease, which requires more radical resection. Both subtotal p
rocedures can be done with comparable low morbidity.