Less than total thyroidectomy for goiter: when and how?

Abstract

Benign goiter is the most common endocrine disease that requires surgery, especially in endemic areas suffering from iodine-deficiency. Recent European and American guidelines recommended total thyroidectomy for the surgical treatment of multinodular goiter. Total thyroidectomy has now become the technique of choice and is widely considered the most reliable approach in preventing recurrence. Nevertheless, total thyroidectomy carries a substantial risk in terms of hypoparathyroidism and the morbidity associated with injury to the inferior laryngeal nerve. In this context, partial/less-than-total thyroidectomy is being considered once again as a viable alternative. This review will discuss the extent of thyroid surgery for benign disease and the impact of the surgical protocol on the patient- and surgeon-specific risk factors for specific complication rates.

Keywords: Goiter; hypoparathyroidism; recurrent nerve injury; thyroidectomy.

Figure 1

Subtotal thyroidectomy. TC, thyroid cartilage; SLNEB, superior laryngeal nerve external branch; CPM, cricopharyngeal muscle; E, esophagus; PT, parathyroid; RLN, recurrent laryngeal nerve; Tr, trakea.

Figure 2

(A) Thyroid dissection from surrounding tissues and Berry’s ligament; (B) lateral view of total thyroidectomy. Total thyroidectomy (C1) and hemithyroidectomy (C2). TC, thyroid cartilage; SLNEB, superior laryngeal nerve—external branch; CPM, cricopharyngeal muscle; E, esophagus; PT, parathyroid; RLN, recurrent laryngeal nerve; Tr, trakea.

Figure 3

Dunhill procedure. Is, isthmus; R, remnant.