Total Thyroidectomy in Benign Multinodular Goitre

Abstract

Introduction: Total thyroidectomy is the standard surgical procedure for thyroid malignancy. Many surgeons do not perform total thyroidectomy in cases of Benign Multinodular Goitre (BMNG) owing to the fear of recurrent laryngeal nerve (RLN) damage and postoperative risk of hypoparathyroidism. Long term thyroxin therapy with its side effects is an additional factor. We conducted this study to assess total thyroidectomy as a safe option for managing BMNG. Setting: Surgical Unit-I and Surgical Unit-III, Allied Hospital, a tertiary care hospital affiliated with Punjab Medical College, Faisalabad. Duration of study was two years from January 2008 to January 2010 Material and Methods: A total number of 196 consecutive patients undergoing total thyroidectomy (TT) for BMNG were included in this study. Patients with thyroid malignancy or suspicion of malignancy were excluded. Preoperative assessment included baseline biochemical workup and thyroid function tests. Preoperative serum calcium and indirect laryngoscopy (IDL) was performed in all the  patients. Postoperative assessment included serum calcium estimation after 24 hrs and 07 days of TT. IDL was considered in any patient with suspected RLN palsy. Drain output was recorded at 24 hrs after3 . Results: Total number of 196 patients were included with 49 male and 147 female (male to female ratio of 1:3). Age ranged from 14-60 yrs (mean:37 yrs). One thirty six patients undergoing TT had Non- Toxic MNG while 60 patients had Toxic MNG controlled on antithyroid drugs. Drain output ranged from10-100 ml in 24 hrs. No patient developed permanent RLN palsy. Seven patients (3.5%) had temporary unilateral RLN palsy. Fifty six patients (28.5%) developed temporary hypocalcemia. None of the patients developed permanent hypocalcemia. Two patients developed seroma formation which was aspirated with wide bored needle. Two patients got superficial wound infection which recovered with oral antibiotics. Postoperative hemorrhage requiring re- exploration did not occur in any patient. Postoperative stay ranged from 2-4 days. Most of the patients were discharged 48 hrs after surgery. There was no postoperative mortality. Conclusion: Total Thyroidectomy is a safe method for treating Benign Multinodular Goitre in experienced hands with low postoperative complications and morbidity.