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Long-term sequelae of the less than total thyroidectomy procedures for benign thyroid nodular disease

  • Endocrine Surgery
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Abstract

Introduction

Nodular goiter is the most common disorder of the thyroid gland. Less than total thyroidectomy procedures are considered the gold standard in the surgical management of nodular thyroid disease despite its propensity for recurrence. The aim of the study was to assess long-term sequelae of the less than total thyroidectomy procedures.

Material and methods

In this single-center retrospective study, records of 154 patients that underwent less than total thyroidectomy, for nodular disease and/or hyperthyroidism between 1998 and 2013, were reviewed. Patients with malignant findings in the histology report and a follow-up of less than 5 years were excluded.

Results

The mean age of the recorded patients was 65.1 ± 12.91 years of which 132 were females. Subtotal thyroidectomy was performed in 45.5% of the study population, 22.1% underwent partial thyroidectomy, while the remaining 32.5% underwent lobectomy. Long-term thyroxine supplementation was administered in 138 patients (89.6%). Recurrence of clinically important nodules (>1 cm) was observed in 68.2% of patients but only 11% of the population underwent completion thyroidectomy. In the univariate analysis, the duration of follow-up (p = 0.00005, C.I.: 0.903–0.965) as well as the type of operation (p = 0.035, C.I.: 1.031–2.348) appeared to have a significant correlation with nodular recurrence. The multivariate analysis identified the duration of follow-up (p = 0.0005, C.I.: 0.908–0.973) as the only significant predictive factor of nodular recurrence.

Conclusion

This is the first study with such a long duration of post-operative follow-up. The high rate of nodular recurrence in less than total thyroidectomy procedures along with the lifelong need for thyroxine supplementation suggest that a more conservative surgical approach is needed. When surgery is recommended, we suggest total thyroidectomy as the treatment of choice to avoid the recurrence of disease, the high cost associated with frequent follow-ups by means of sonography as well as thyroxine replacement therapy.

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Author notes

  1. These authors contributed equally: Georgios Boutzios, Gerasimos Tsourouflis.

Authors and Affiliations

  1. Department of Pathophysiology, Laiko University Hospital, Medical School, University of Athens, Athens, Greece

    Georgios Boutzios & Krystallenia Alexandraki

  2. Second Department of Propaedeutic Surgery, Laiko University Hospital, Medical School, University of Athens, Athens, Greece

    Gerasimos Tsourouflis, Zoe Garoufalia & Grigorios Kouraklis

Authors
  1. Georgios Boutzios
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  2. Gerasimos Tsourouflis
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  3. Zoe Garoufalia
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  4. Krystallenia Alexandraki
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  5. Grigorios Kouraklis
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Correspondence to Georgios Boutzios.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Boutzios, G., Tsourouflis, G., Garoufalia, Z. et al. Long-term sequelae of the less than total thyroidectomy procedures for benign thyroid nodular disease. Endocrine 63, 247–251 (2019). https://doi.org/10.1007/s12020-018-1778-y

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  • DOI: https://doi.org/10.1007/s12020-018-1778-y

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