A comparison of total thyroidectomy and lobectomy in the treatment of dominant thyroid nodules

Patients with a clinically concerning dominant thyroid nodule have been managed by lobectomy or total thyroidectomy at our institution. We determined the complications associated with both approaches and the ability of thyroid lobectomy to avoid the need for thyroid hormone replacement therapy. Records of all patients with a dominant thyroid nodule managed with surgery from August 1993 through December 2000 were reviewed for demographics, history of head and neck radiation, indication for surgery, preoperative fine-needle aspirate results, final pathologic evaluation, perioperative complications, determinations of need for subsequent thyroid surgery after lobectomy, and need for thyroid hormone replacement therapy after surgery. Patients with a preoperative diagnosis of malignancy or bilateral or diffuse disease were excluded because these conditions would uniformly be managed by bilateral thyroidectomy. The complications for the lobectomy group (n = 131) compared with the total thyroidectomy group (n = 84) were: recurrent laryngeal nerve paresis (4.6% vs 2.4%), recurrent laryngeal nerve injury (0.8% vs 0), and transient hypoparathyroidism (1.5% vs 9.5%; P = 0.007). No permanent hypoparathyroidism was identified in either group. Postoperative thyroid hormone replacement was required in 64 of 131 lobectomy patients (48.8%). Complications associated with either surgery were low. Total thyroidectomy was not associated with clinically significant additive morbidity. Patients treated by lobectomy should be aware of a nearly 50 per cent chance of requiring thyroid hormone replacement. Total thyroidectomy avoids future thyroid surgery; lobectomy patients remain at risk. When complications can be minimized total thyroidectomy should be considered an option in the management for patients with dominant thyroid nodules that require surgery.     

Near-total thyroidectomy could be the best treatment for thyroid disease in endemic regions

HYPOTHESIS: Near-total thyroidectomy, on the basis of its low morbidity rate, is an appropriate treatment option in the surgical management of various thyroid diseases in an endemic region in Turkey. DESIGN: Single-institution study of patients with various thyroid diseases treated by means of near-total thyroidectomy within 2 years in an endemic region, with comparison of the results vs the complication rates of bilateral subtotal and total thyroidectomy reported in the literature. SETTING: Tertiary academic referral center. PATIENTS: One hundred fifty-two patients who underwent near-total thyroidectomy for various thyroid diseases. MAIN OUTCOME MEASURES: Surgical treatments of various benign thyroid diseases were compared according to the complication rates and the achievable benefits of the procedures. RESULTS: In our clinic, near-total thyroidectomy was the principal surgical procedure performed for benign thyroid disease. The temporary recurrent laryngeal nerve palsy rate with respect to the nerves at risk was 3.3% (10 of 304 nerves), whereas temporary hypoparathyroidism was 7.2% (11 of 152 patients). Neither permanent recurrent laryngeal nerve palsy nor permanent hypoparathyroidism occurred. In 1 patient, wound hematoma developed and required re-exploration. Seroma in another patient needed no medical or surgical intervention. Neither wound infection nor mortality were noted. CONCLUSIONS: Near-total thyroidectomy achieves a lower complication rate of hypoparathyroidism and a similar complication rate of recurrent laryngeal nerve palsy and recurrence when compared with the rates reported in the literature for total thyroidectomy. It is an effective and safe surgical treatment option for various benign thyroid diseases.     

Surgical treatment of solitary thyroid nodule

In this report we examine the surgery of solitary thyroid nodules, outlining the operations performed and the diagnostic-instrumental procedures aimed at identifying the degree of malignancy of the lesion. If intraoperative cytological and histological examination of a nodule show that it is benign, we perform lobectomy. In a total of 400 cases, we performed 52 (13%) nodule resections, 276 (69%) hemithyroidectomies, and 72 (18%) extended resections comprising the isthmus and Laluette pyramid. Twenty-five patients (5%) were affected by differentiated cancers arising in the nodule. In this group, the carcinoma diagnosis, revealed by fine the needle aspiration and confirmed at the intraoperative examination, allowed us to perform a total thyroidectomy in a single session in 21 cases (84%); more specifically, total thyroidectomy only was performed in 14 (56%) cases, while in 7 cases (28%) a laterocervical lymph-node resection was also necessary due to the presence of lymph nodes of increased volume. We had three cases with lesions of the recurrent nerve (0.6%) and 30 with irritation of the superior laryngeal nerve (6%) which caused temporary hypoaesthesia of the larynx and hoarseness. Moreover, four patients (8%) presented temporary postoperative hypoparathyroidism. No instances of permanent hypoparathyroidism were observed. The report concludes by analysing a number of surgical techniques for the treatment of solitary thyroid nodules.     

甲状腺全切除术的适应证及安全性分析

目的探讨甲状腺全切术的手术适应证以及并发症的防治。方法回顾性分析2009年1月至2011年12月期间在笔者所在医院接受甲状腺全切除术的85例患者的临床资料。85例中甲状腺癌46例,结节性甲状腺肿38例,桥本甲状腺炎1例。分析其手术过程以及术后并发症。结果术后病理检查提示46例甲状腺癌中9例（19.6%）为双侧癌;38例结节性甲状腺肿患者均为双侧多发结节。全部患者均解剖出2条喉返神经,有4例患者的喉返神经被肿瘤侵犯,其中1条喉返神经被切除。有5例患者术中未能明确看到并保留甲状旁腺,其余患者均保留了1枚或以上的甲状旁腺。有2例患者术后发生出血需再次手术止血;有6例患者术后出现声音嘶哑,除1例喉返神经被切除者之外,其余患者声音均恢复正常;33例（38.8%）患者出现一过性低钙血症症状;2例患者出现永久性甲状旁腺功能低下。结论甲状腺全切除术是治疗双侧结节性甲状腺肿和甲状腺癌的安全术式,术中显露喉返神经与鉴别甲状旁腺可有效防止相应并发症的发生。肿瘤侵犯喉返神经并不一定导致患者声音嘶哑。     

Early results after minimal lobectomy for benign nodular goiter

Following traditional operations (enucleation and subtotal resection) for benign nodular goiters recurrences may develop. Reoperations for this condition can cause complications, such as hypoparathyroidism and damage of the recurrent laryngeal nerve. That is why total thyroidectomy is recommended by many specialists in benign thyroid disease. We performed lobectomy on one side, and, if necessary, partial resection on the other side. Lobectomy was performed on one side in 31 cases, with partial resections on the other side in 73 patients. We tried to identify the parathyroid glands and both recurrent laryngeal nerves. Postoperative complications were evaluated. Temporary dysfunction of the recurrent laryngeal nerve was detected in 2.3%, permanent damage in 1.1%. Temporary hypocalcaemia developed in 16.4%, permanent hypocalcemia in 1.9%. Two reoperations were necessary for bleeding. Because of the low postoperative complication rate we recommend this method as an alternative to thyroidectomy for benign nodular goiters. We know that our favourable results can be compared with traditional subtotal resection and thyroidectomy when long term results of thyroid function and data about nodular recurrences will be collected.     

Safety of total thyroidectomy

BACKGROUND: Total thyroidectomy is the preferred operation for multinodular goitre, Graves' disease and thyroid cancer. This study reviewed prospectively collected data on a personal consecutive series of 336 total thyroidectomies to assess whether results reported in world centres of excellence could also be achieved elsewhere. METHODS: Between 1991 and 2004, 336 total thyroidectomies (85% over the last 6 years) of median age 53 years (13-86 years) and male : female ratio of 1:4.3 were undertaken for multinodular goitre 232 (69%), Graves' disease 26 (7.7%), thyroid cancer 60 (17.9%) and other benign conditions 17 (5.4%). Thirty-nine patients had 2-stage procedures. No patient required median sternotomy. Parathyroid autotransplantation was carried out in 43 (12.8%). RESULTS: Permanent unilateral recurrent laryngeal nerve palsy occurred in 0.3% and permanent hypoparathyroidism in 1.8%. Significant temporary hypocalcaemia occurred in 13.4%. Non-significant temporary hypocalcaemia occurred in 23.8%, resulting in an overall rate of hypocalcaemia of 38.9% for the total series. Hypocalcaemia was more common after 1-stage compared with 2-stage surgeries (P < 0.001). Temporary hypocalcaemia was commoner after surgery for Graves' disease than surgery for other conditions. The rate of postoperative haemorrhage was 0.9% and wound infection, 1.5%. There was no postoperative mortality. CONCLUSION: Total thyroidectomy removes the disease process completely, lowers local recurrence rates and avoids the substantial risks of reoperative surgery. Total thyroidectomy is safe and can be carried out with low complication rates that are equal to world centres of excellence.     

Reoperative surgery for thyroid disease

Background and aims Reoperative surgery for thyroid disease is rare. However, it is sometimes indicated for nodular recurrence after partial surgery for initially benign thyroid disease or for a completion total thyroidectomy when a final diagnosis of well-differentiated thyroid cancer (WDTC) is confirmed on a permanent section of a partially removed thyroid gland. This surgery can expose the patient to postoperative complications such as recurrent laryngeal nerve (RLN) palsy or hypoparathyroidism. The aims of our study were to describe the population subjected to reoperative thyroid surgery and to evaluate postoperative morbidity to find the risk factor. Patients and methods The present study is a retrospective analysis of our experience with completion thyroidectomy: 685 consecutive patients underwent this procedure in a 14-year period, for a recurrent uninodular (85 patients) or multinodular (333 patients) goiter, recurrent thyrotoxicosis (42 patients), or a completion thyroidectomy for WDTC after partial resection of the thyroid gland (225 patients). The operative technique was standardized with identification of the RLN and parathyroid glands before removal of the thyroid gland. l-Thyroxin treatment was started the day after surgery. Postoperative rates of suffocating hematoma, wound infection, RLN palsy, hypoparathyroidism, and persistence or recurrence of hyperthyroidism were studied and compared to the same parameters in patients who underwent primary bilateral thyroid gland resection during the same period. Results The transient morbidity rate was 8%, with 5% hypoparathyroidism, 1.2% RLN palsy, 0.9% suffocating hematoma, and 0.2% wound infection. These results were higher than those from cases of primary thyroid resection for bilateral disease. Within the secondary surgery group, postoperative complications depended on the mean weight of the resected thyroid gland, hyperthyroidism, and the bilaterality of thyroid exploration during the previous surgery. The permanent morbidity rate was 3.8%, including 1.5% RLN palsy and 2.5% hypoparathyroidism. Permanent complication rates were higher than those for primary thyroid resection. Incidental carcinoma was found in 92 patients (13%): 10% (42 of 418) in patients with recurrent euthyroid nodular disease, 7% (3 of 42) in patients with recurrent hyperthyroidism, and 21% (47 of 225) in patients who underwent a completion thyroidectomy for cancer. Conclusion Because reoperative thyroid surgery can lead to potential complications, especially permanent RLN palsy or hypoparathyroidism, it should be reserved for patients who need it. The importance of respecting specific technical rules should be emphasized.     

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??Application and assessment of total thyroidectomy for benign thyroid nodules ZHANG Hao. Department of General Surgery??the First Hospital of China Medical University??Shenyang 110001??China
Abstract Thyroid nodule is a common disease in clinical practice. Although the majority of thyroid nodules have been found to be benign. Some of them need to be surgically excised when meeting the indications. The thyroid operations include lobectomy??subtotal thyroidectomy and total/near total thyroidectomy??etc. The preferred operation for benign thyroid nodules remains controversial. Less extensive resection may be related to a higher risk of recurrence. While more extensive resection may be associated with a higher risk of recurrent laryngeal nerve injury or hypoparathyroidism. Total thyroidectomy has been used to treat benign thyroid nodules for a long history. It is an operation that can be safely performed nowadays??with low incidence of permanent complications. It has been the optimal surgery that can prevent recurrence and avoid reoperation in cases of benign thyroid nodules such as multiple nodular goiter in foreign countries since a long time ago. It is also suggested to perform the operation in case of bilateral benign thyroid nodules with surgical indications given the different technical levels of surgeons and different situation of individual patient in China.     

侵犯甲状腺包膜的甲状腺微小癌的外科治疗

目的：探讨侵犯甲状腺包膜的甲状腺微小癌的外科治疗方法。方法：对24例侵犯甲状腺包膜的甲状腺微小癌均行功能性颈部清扫及双侧甲状腺全切术。结果：术后并发暂时性喉返神经损伤2例,暂时性甲状旁腺功能减退8例,乳糜瘘1例。结论：对侵犯甲状腺包膜的甲状腺微小癌患者,应行功能性颈部清扫及双侧甲状腺全切术,兼顾手术的彻底性和机体功能的保留,尽量避免各种并发症。     

甲状腺全切除术治疗良性甲状腺疾病128例临床疗效

目的：探讨甲状腺全切除术治疗甲状腺良性疾病的疗效及术后并发症的预防。方法：回顾性分析128例行甲状腺全切除术的甲状腺良性疾病病人的临床资料,其中首次手术者98例,再次手术者30例。分析总结该128例病人的术后并发症。结果：128例病人术后均未发生永久性甲状旁腺功能低下和永久性喉返神经损伤。首次甲状腺全切除组术后暂时性喉返神经损伤和暂时性甲状旁腺功能低下的发生率均为1．02％,再次手术组的发生率明显增高,分别为10．00％和13．33％,两组比较,Fisher精确概率P分别为0．040、0．011。两组暂时性喉上神经损伤发生率均很低,无明显差别。结论：对符合指征的良性甲状腺疾病,甲状腺全切除术是一合适的治疗选择。熟悉甲状腺解剖和精细手术操作,可有效预防并发症发生。     

COMPLETION TOTAL THYROIDECTOMY IN THE MANAGEMENT OF DIFFERENTIATED THYROID CARCINOMA

Background: Completion thyroidectomy is the removal of any thyroid tissue that remains after a less than total thyroidectomy. This procedure has been commonly performed when the final histopathology of the excised ipsilateral thyroid lobe reveals papillary or follicular carcinoma of the thyroid. Complete thyroidectomy carries little morbidity if performed by experienced surgeons using a lateral approach. The purpose of this study is to reinforce the usefulness of a lateral approach. Methods: A retrospective analysis over a 5 year period at the Department of Endocrine Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) yielded 19 patients who underwent completion thyroidectomy. This group represents 23% of 82 patients who underwent total thyroidectomy for differentiated thyroid cancer (DTC) during that period. The residual thyroid tissue was excised through a lateral approach and could be resected safely, preserving the recurrent laryngeal nerve (RLN) and the parathyroid glands. Results: A lateral approach dissection could be performed with ease in a virgin area. Excision of residual thyroid tissue could be performed safely even in cases with prior partial lobectomy or bilateral subtotal resection. Tumour was found in 52% of the re-operative specimens: in three out of four of those after a previous partial lobectomy, in six out of 12 of those after a total lobectomy, and in one out of three of those after a prior bilateral (although incomplete) thyroid resection. Postoperative complications included transient RLN palsy (n = 2) and transient hypoparathyroidism (n = 4). Conclusions: Completion thyroidectomy using a lateral approach is safe in re-operative thyroid surgery.     

Autotransplantation of at least one parathyroid gland during thyroidectomy in benign thyroid disease minimizes the risk of permanent hypoparathyroidism

OBJECTIVE:Permanent hypoparathyroidism is a distressing complication of thyroid surgery. The reported incidence varies between 0.4 and 13.8 % and is directly correlated to the extent of thyroidectomy. The aim of this retrospective study was to analyze whether simultaneous autotransplantation of at least one parathyroid gland during total thyroidectomy for benign thyroid disease could reduce the risk of permanent hypoparathyroidism. METHODS: Since 01/1999 all thyroid operations are prospectively recorded. Beside daily postoperative measurement of serum calcium level, iPTH is routinely determined on the third post op day. Patients with complications are followed closely. Postoperative hypoparathyroidism persisting for more than 6 months is defined permanent. RESULTS: Between 01/1999 and 02/2001 146 total thyroidectomies for benign thyroid disease have been performed (81 pat. with Graves disease, 62 with nodular goiter, 3 with thyroiditis de Quervain/Hashimoto). In 37 pat. (25 %) at least one parathyroid gland was simultaneously autotransplanted into the ipsilateral sternocleidomastoid muscle. Group I (no parathyroid autotransplantation, n = 109) and group II (parathyroid autotransplantation, n = 37) were comparable concerning patient age, thyroid disease and lowest post op calcium level (2.07 versus 2.05 mmol/l). The incidence of postoperative symptomatic hypocalcemia (14.7 % versus 21.6 %) and temporary hypoparathyroidism (15.6 % versus 18.9 %) was higher in group II patients (n. s.). Conversely, permanent hypoparathyroidism occurred exclusively in group I patients (2.75 %), patients with parathyroid autotransplantation (group II) did not develop this complication. CONCLUSIONS: Simultaneous autotransplantation of at least one parathyroid gland during total thyroidectomy for benign thyroid disease seems to minimize the risk of permanent hypoparathyroidism. The potential of routine autotransplantation in this setting has to be evaluated. The incidence of postoperative temporary hypocalcemia may be elevated with this policy.     

Complications of Thyroid Surgery: Analysis of a Multicentric Study on 14,934 Patients Operated on in Italy over 5 Years

Complication rates associated with thyroid surgery can be evaluated only through analysis of case studies and follow-up data. This study covers postoperative data from 14,934 patients subjected to a follow-up of 5 years. Among them, 3130 (20.9%) underwent total lobectomy (TL), 9599 (64.3%) total thyroidectomy (TT), 1448 (9.7%) subtotal thyroidectomy with a monolateral remnant (MRST), and 757 (5.1%) subtotal thyroidectomy with bilateral remnants (BRST). A total of 6% of the patients had already been operated on. Persistent hypoparathyroidism occurred after 1.7% of all the operations, and temporary hypoparathyroidism was noted in 8.3%. Permanent palsy of the laryngeal recurrent nerve (LRN) occurred in 1.0% of patients, transient palsy in 2.0%, and diplegia in 0.4%. The superior laryngeal nerve was damaged in 3.7%; dysphagia occurred in 1.4% of cases, hemorrhage in 1.2%, and wound infection in 0.3%. No deaths were reported. A significant rate of LRN damage was noted, which has an important impact on the patients social life. Hypoparathyroidism after total thyroidectomy is an important complication that can be successfully treated by therapy, although it is not always easily managed in special circumstances such as in young persons or pregnant women. The complications associated with thyroid surgery must be kept in mind so the surgeon can carefully evaluate the surgical and medical therapeutic options, have more precise surgical indications, and be able to give the patient adequate information.     

Completion thyroidectomy for differentiated thyroid carcinoma

Completion thyroidectomy is performed because of a deferred diagnosis of differentiated carcinoma of the thyroid or a significant thyroid remnant after initial operation. During a period of 6 years, data from 40 patients with differentiated thyroid carcinoma undergoing completion thyroidectomy were retrospectively reviewed. There were 4 men and 36 women (1:9), and the average age was 39.6 ± 1.9 years (range, 20 to 62 years). The indications for the initial surgery were a solitary thyroid nodule in 36 (90%) patients, multinodular goiter in 3 (7.5%) patients, and Graves’ disease in 1 (2.5%) patient. Three patients underwent completion thyroidectomy during the same hospital stay. In the remaining 37 patients, completion thyroidectomy was performed 4 to 252 days (44.1 ± 7.8 days) after the initial operation. The length of hospital stay for the initial operation was not different from that for completion thyroidectomy (5.1 ± 0.3 days vs. 5.2 ± 0.3 days). The length of time needed to accomplish the initial operation was not different from that required for the completion thyroidectomy (122 ± 7.5 minutes vs. 110.8 ± 5.9 minutes). There was no 30-day perioperative mortality. The postoperative morbidity in completion thyroidectomy consisted of transient hypoparathyroidism in 3 (7.5%) patients, permanent hypoparathyroidism in 1 (2.5%) patient, transient recurrent laryngeal nerve palsy in 1 (2.5%) patient, and permanent recurrent laryngeal nerve palsy in 1 (2.5%) patient. On the other hand, one transient recurrent laryngeal nerve palsy and one transient hypoparathyroidism occurred at the initial operation. Completion thyroidectomy is a safe procedure to remove the thyroid remnant. (Otolaryngol Head Neck Surg 1998;118:896-9.)     

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??Surgical indication , key point and prevention of complication of total thyroidectomy ZENG Zhi-jun??OU Di-peng,??YANG Lian-yue. Department of Surgery, Xiangya Hospital, Central South University, Changsha 410008, China
Corresponding author??YANG Lian-yue??E-mail:lianyueyang@hotmail.com
Abstract Objective To discuss the surgical indication, key point and prevention of complication of total thyroidectomy. Methods A retrospective analysis of the clinical records of 107 patients from March 2000 to March 2010 at Xiangya Hospital, Central South University undergoing total thyroidectomy was analyzed for the treatment for thyroid diseases. Results Total thyroidectomy was performed in 107 patients including 71 cases of thyroid carcinoma, 25 cases of giant nodular goiter, 6 cases of hyperthyroidism, 5 cases of Hashimoto thyroiditis. All patients discharged and postoperative complications incidence was 4.6%. Two patients had one-sided recurrent laryngeal nerve injury and temporary hypoparathyroidism occurred in 2 cases. One case had neck swelling in 24 hours. Conclusion Total thyroidectomy could be indicated as differentiated thyroid carcinoma. Precise operation is important to prevent the postoperative complication.     

Total thyroidectomy for clinically benign disease of the thyroid gland

BACKGROUND: The role of total thyroidectomy in the treatment of patients with benign thyroid disease remains controversial. However, this procedure may be appropriate when both thyroid lobes are involved and when the risk of recurrence is significant. This study is a review of a 15-year experience of total thyroidectomy for benign disease. METHODS: Between 1988 and 2002, 834 patients underwent total thyroidectomy for clinically benign disease at the Sydney Head and Neck Cancer Institute, Royal Prince Alfred Hospital. There were 128 men and 706 women with a mean age of 52 (range 16-91) years. Indications for surgery were euthyroid multinodular goitre (MNG), toxic MNG and Graves' disease in 730 (87.5 per cent), 57 (6.8 per cent) and 47 (5.6 per cent) respectively. A total of 74 patients had previously undergone partial thyroidectomy. RESULTS: The incidence of temporary recurrent laryngeal nerve palsy was 2.3 per cent and that of temporary hypoparathyroidism 14.4 per cent. Permanent recurrent laryngeal nerve palsy occurred in 1.1 per cent, and 2.4 per cent of patients had permanent hypoparathyroidism. Neither the initial clinical diagnosis nor a history of previous treatment significantly influenced the rate of complications. The incidence of malignancy, other than incidental microscopic papillary carcinoma, was 4.6 per cent. CONCLUSION: Total thyroidectomy has an important role in the management of patients with benign disease when both lobes of the thyroid gland are involved. This approach avoids disease recurrence and the increased risk of morbidity associated with secondary operation.     

内镜甲状腺手术对甲状旁腺的辨别与保护研究

目的探讨在内镜甲状腺手术中辨别和保护甲状旁腺的方法。方法回顾性分析2006年10月至2010年7月160例行颈前小切口内镜辅助甲状腺手术患者的临床资料,其中甲状腺瘤58例,结节性甲状腺肿82例,原发性甲状腺功能亢进16例,甲状腺乳头状癌4例。行一侧甲状腺次全切除术90例,双侧甲状腺次全切除术46例,甲状腺全切术20例,甲状腺全切术＋中央组淋巴结清扫4例,术中均对甲状旁腺进行精确辨认及有效保护。结果 160例均成功完成手术,术后暂时性甲状旁腺功能减退4例（2.5%）,未出现永久性甲状旁腺功能减退。结论内镜辅助甲状腺手术在术中可通过内镜放大作用对甲状旁腺进行精确辨认,并在内镜视野下完成对甲状旁腺血供的精细解剖和分离,有效的保护了甲状旁腺及其血供,明显降低了术后甲状旁腺功能减退并发症的发生率。     

全甲状腺切除在甲状腺良性结节治疗中应用及评价

甲状腺结节临床常见,尽管大部分为良性,但有手术指征时应行手术治疗,手术方式主要包括腺叶切除、甲状腺次全切除和全（近全）甲状腺切除等。甲状腺良性结节的手术方式目前尚存争议,若切除范围过小,结节复发风险增加,可能须再次手术;切除范围过大,则可能增加喉返神经损伤及甲状旁腺功能减退等并发症发生风险。全甲状腺切除因其能彻底切除病变,降低复发风险,避免再次手术,且并发症无明显增加,已成为国外治疗结节性甲状腺肿等良性甲状腺结节的首选术式。在我国,应综合考虑医生的技术水平、病人的个体情况及意愿等因素,可以考虑对具有手术指征的双叶甲状腺良性结节采用全甲状腺切除术。     

Isthmectomy: A Conservative Operation for Solitary Nodule of the Thyroid Isthmus

Purpose : To assess the results obtained in patients with nontoxic uninodular goiter confined to the isthmus undergoing isthmectomy.

Methods : Between April 1994 and June 2006, 330 consecutive patients with nontoxic uninodular goiter underwent thyroidectomy at our institution. In 31 patients, lesions were limited to the thyroid isthmus with evidence of benign or undetermined pathology on ultrasound-guided fine-needle aspiration biopsy. Total isthmectomy was performed. Results : Preoperatively, thyroid nodules on ultrasonography were solid in 26 patients and mixed with cystic and solid components in 2. The mean size of nodules was 2.43 (± 0.88) cm. No intraoperative or postoperative complications occurred. Histological examination showed nodular hyperplasia in 29 cases, follicular adenoma in 1 and papillary thyroid carcinoma in 1. The patient with papillary carcinoma underwent bilateral lobectomy 7 days later. A total of 24 patients (77.4%) attended clinical visits at follow-up (mean 70, 57 months). Ultrasonographic scanning revealed thyroid nodules in 17 patients, in 16 of which nodules range from one to five (0.5 to 2 cm in size) and further surgery was not indicated. One patient with a 4-cm nodule and tracheal displacement found at ultrasonography 2 years after isthmectomy had inconclusive results of FNAB. This patient was re-operated for completion thyroidectomy, which was successfully performed without technical difficulties. The detection of recurrent nodules was independent of the time elapsed since thyroid isthmectomy.

Conclusions : These findings document the feasibility and efficacy of isthmectomy in solitary thyroid nodules confined to the isthmus.     

甲状腺良性结节手术后复发的再治疗

目的 探讨甲状腺良性结节手术后复发的相关因素和再治疗原则。方法 对我院18年中51例甲状腺良性结节手术后临床复发者的病理、手术适应证、术式以及再治疗进行回顾性分析。结果 甲状腺良性结节手术后复发与病变性质、单发或多发、手术适应证的掌握及术式的选择密切相关。51例复发者中结节性甲状腺肿29例,甲状腺瘤22例;其中行结节摘除21例,腺叶部分切除16例,一侧腺叶次全切除9例,一侧腺叶切除5例。再手术38例,行一侧腺叶切除19例,一侧叶切加对侧次全切除3例,一侧次全切除7例,双侧次全切除9例;无严重手术并发症。随访32例再手术者,平均7年,仅1例结节性甲状腺肿再复发。结论 对甲状腺瘤和结节性甲状腺肿的正确诊断、明确病变的单发或多发,严格掌握多发性结节性甲状腺肿的手术适应证,并废弃结节摘除和腺叶部分切除术可降低复发率和再手术率。