SURGICAL PRACTICE AND RISK FACTORS IN THE TREATMENT OF PATIENTS WITH BENIGN THYROID DISEASES
Abstract:
The extent of surgery for unilateral or bilateral disease is controversial. Bilateral resection should be associated with low recurrence rates, but with a higher technical morbidity. The aim of this study is to present our experience with benign thyroid diseases treated by either subtotal, total or near total thyroidectomy, and the existence of cold nodules and the frequency of thyroid carcinoma in hyperthyroid patients. Methods: There were reviewed the medical records of 815 patients who underwent operations for toxic multinodular goiter-struma (TMS) (n=298), Sraves’ diseases (SD) n=341, and toxic adenoma (TA) n=176 between January 1990 and April 2013. During this period of time, the patients underwent subtotal unilateral or total thyroidectomy for benign disease. Results: The incidence of thyroid carcinoma was of 6.4% (352/815); cold nodules were found in 292 (36%) of the patients and no cold nodules were found in 523 (63%) of the patients. In SD, 3.7% of the patients had carcinoma, its incidence in the patients with TMS being of 6.3%. The recurrence rate in the lobectomy group was of 11%, versus 3% after total thyroidectomy. However, patients in the lobectomy group had a much lower complication noted (2%) versus 9% after thyroidectomy (p=0.007). Conclusions: In patients with MMS, 89% of those with unilateral resection did not require further surgery. The morbidity after unilateral thyroidectomy was lower than for bilateral resection. The present data support the recommendation for the unilateral lobectomy in the selected cases with symptomatic unilateral MMS.
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