Comparative Study of Total Thyroidectomy and Subtotal Thyroidectomy Regarding the Surgical Management of Multinodular Goiter
Background : Multinodular goitre refers to a generalised enlarged thyroid gland with recognisable nodules within it. The most frequent cause of multinodular goitre is iodine deficiency. Medical care or radioactive iodine may be used for larger goitres; but the best choice of MNG treatment is surgery, especially in cosmetic problem, compressive symptom, toxicity and suspicion of malignancy. There are several methods for thyroid gland operation such as Subtotal Thyroidectomy (STT), Near-Total Thyroidectomy (NTT), Hemi-thyroidectomy plus Subtotal resection (Dunhill procedure) and Total Thyroidectomy (TT). But the surgical method of benign thyroid disease treatment is still controversial. Objective : The primary objective of this study was to assess the effects of total or near-total thyroidectomy compared to subtotal thyroidectomy for multinodular non-toxic goitre. Materials and Methods : The study included fifty seven patients admitted at Gandhi Hospital referred with a prior diagnosis of TMNG. 28 patients had undergone Subtotal Thyroidectomy where as 29 patients had undergone Total Thyroidectomy. Results were interpreted based on the Thyroid profile, serum Calcium values; Incidence of post-operative complications and recurrence of goitre. Results : The results showed that among the patients who had undergone total thyroidectomy only two patients had developed the complications of recurrent laryngeal nerve injury, superior laryngeal nerve injury, hypothyroidism and hypoparathyroidism, whereas among the patients who underwent subtotal thyroidectomy none of these complications were seen; 5 patients out of 28 who had undergone subtotal thyroidectomy had developed recurrence at the end of 1 year, whereas there was no evidence of recurrence among the patients who had undergone total thyroidectomy and the difference was found to be statistically significant. Cocnclusions : It has been concluded that despite of the higher rate of post-operative complications, total thyroidectomy will be more effective and beneficial in the surgical treatment of Multinodular Goitre.