Total thyroidectomy for bilateral benign multinodular goiter - Effect of changing practice

Hypothesis: That changing practices in a single institution toward performi ng total thyroidectomy as the preferred option for the treatment of bilater al benign multinodular goiter (BMNG) can alter attitudes and practice withi n an entire region (Australia and New Zealand). Design: (1) Single-institution study of patients with bilateral BMNG treate d by thyroidectomy over a 40-year period, examining the changing pattern of use of bilateral subtotal thyroidectomy and total thyroidectomy in the ini tial surgical treatment of nodular goiter. (2) Mail survey of all endocrine surgeons (n = 75) in Australia and New Zealand, seeking information on the ir changing practice in the surgical treatment of BMNG. Setting: Tertiary academic referral center. Patients: A group of 3468 patients who underwent thyroidectomy for bilatera l BMNG during the study period. Of these, 1838 had a subtotal thyroidectomy performed and 1251 had a total thyroidectomy as the primary surgical treat ment. Main Outcome Measures: The changing incidence of each type of thyroid proce dure each year over the study period. Results: Within our unit, bilateral subtotal thyroidectomy was the principa l procedure performed until 1984, when total thyroidectomy became the prefe rred procedure. Our unit now treats 94% of these patients with total thyroi dectomy. Secondary thyroidectomy for recurrent goiter initially increased o ver the years (with a lag period of 13 years), reflecting the numbers of su btotal procedures previously performed, and is now declining. This pattern has been reflected throughout Australia and New Zealand; 60% of practicing endocrine surgeons now perform total thyroidectomy as the preferred treatme nt for bilateral BMNG. Conclusions: Total thyroidectomy is a safe and effective treatment for bila teral BMNG, and it is now the routine procedure throughout Australia and Ne w Zealand. Its use has corresponded to a reduction in the need for secondar y thyroidectomy for recurrent goiter.