Place of total thyroidectomy in rhinolaryngologists' surgical treatment of thyroid disease

The factors related with postoperative complications in benign nodular thyroid surgery

Thyroid gland is an important endocrine organ because of its functions. Although the morbidity and mortality of thyroid surgery have decreased markedly, serious complications may still occur. The aim of this retrospective study was to identify the factors influencing the complications in benign nodular thyroid surgery. A total of 332 patients who underwent thyroid surgery between April 2004 and May 2008 were evaluated retrospectively to identify the factors influencing the complications. We found that in surgery lasting more than 90 minutes the risk of permanent recurrent laryngeal nerve (RLN) injury was high, daily drainage more than 50 cc increases the risk of seroma formation, retrosternal goiter surgery have higher risk for bleeding. The flap edema rates were high found in the operations made by resident surgeon and patients with size 3-4 thyroid glands. Low complication rates can be achieved after thyroidectomy with better knowledge of the surgical anatomy of the neck, thyroid pathology and required surgical treatment.

Complication rates after operations for benign thyroid disease

Controversy persists concerning the use of total thyroidectomy in benign thyroid disease and varying complication rates have been reported. We evaluated the safety of total thyroidectomy or lobectomy in benign thyroid disease. During a 5-year period, 102 patients were operated on for benign thyroid disease, including multinodular goiter (n = 55), solitary nodule (n = 18), toxic nodular goiter (n = 22) and Hashimoto's thyroiditis (n = 7). Recurrent laryngeal nerves were routinely investigated during dissection. Total thyroidectomy was performed in 27 cases, unilateral total lobectomy with isthmectomy in 38 and unilateral total, contralateral subtotal lobectomy in 37. One (0.9%) temporary superior laryngeal nerve palsy, 1 (0.9%) temporary recurrent nerve palsy and 1 (0.9%) temporary hypoparathyroidism occurred. Wound seroma developed in 2 patients (1.9%). There were no deaths or permanent complications. This study shows that total thyroidectomy or lobectomy can be done with minimal morbidity in cases of benign thyroid disease affecting the whole gland.

Thyroid surgery

In a 5-year period we treated 233 patients referred to us with a thyroid swelling. Among them, 39 patients (17%) had a malignant tumor. Seventy-eight percent of the patients were women. The preoperative examination procedure is discussed. Preoperatively, recurrent nerve palsy was found in 2.6% of patients with benign tumors and in 28% of patients with malignant tumors. The histologic features of the benign and the malignant tumors are described. The operative procedure in the benign group consisted of enucleation, resection, or lobectomy. In the patients with malignant tumors a radical operation was performed, consisting of lobectomy (unilateral or bilateral) when possible, eventually combined with radical neck dissection. The operative complications are discussed.