A COMPARATIVE STUDY ON THE OUTCOME OF TOTAL THYROIDECTOMY VERSUS SUBTOTAL THYROIDECTOMY IN MULTINODULAR GOITRES
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 11
Abstract
BACKGROUND Multinodular goitres are one of the most common presentations of thyroid swellings encountered by surgeons. This study aims at comparing the outcome, the safety and efficacy of Total Thyroidectomy versus Subtotal Thyroidectomy for the treatment of multinodular goitres. MATERIALS AND METHODS A total of 127 patients admitted in B and LCH and Victoria Hospital from November 2014 to May 2016 were considered for the study; 64 of whom underwent Total Thyroidectomy and 63 underwent Subtotal Thyroidectomy. Necessary preoperative data was collected and post-operative complications, histopathological review of specimen, incidental thyroid malignancy occurrence, the adjuvant treatment given along with 6-month post-discharge surveillance data were analysed using descriptive statistics with Fisher’s exact test/ Chi-square test. RESULTS Multinodular goitres were most common in the age group of 28 - 47 years with a mean age of 40.1 years. Female-to-Male ratio was 9: 1. Euthyroidism was the most common presentation in both the groups with ultrasonological diagnosis of MNG in 88% of cases. Cytologically Nodular Goitre was the most common diagnosis in both the groups. Post-surgery in both the groups transient hypocalcaemia was the most common complication encountered with 8 cases in TT and 9 cases in STT group. RLN injury was seen in 2 cases of TT and 1 case of STT. Hypertrophic scar was a wound related complication seen in 5 cases of STT and 3 cases of TT. None of the complications were statistically significant. HPE revealed benign MNG in 75% of the total cases, whereas 25% cases had incidental thyroid malignancy, 22 cases in TT group and 11 cases in STT group. Papillary CA- classical and follicular variant being the most common one. All 11 cases in STT group underwent completion thyroidectomy with 2 cases subjected to RIA as well, thereby increasing the risk of exposure to complications. Whereas only 2 cases in TT group of ITC underwent neck dissection as resurgery and 14 were given RIA. The post discharge surveillance conducted revealed Hypothyroidism and Hypocalcaemia being dominant state in the 30 days period and all patients attained Euthyroidism (on a fixed dose of Thyroxine) and normocalcaemia by the end of 180 days with no incidence of long-lasting complications. CONCLUSION Total thyroidectomy for MNGs is a safe and effective treatment option available that provides adequate cure with low incidence of complications as in hypocalcaemia and RLN injury and offers an edge over subtotal thyroidectomy in terms of detection of incidental thyroid cancer and the need for re-surgery and other adjuvant treatment reducing the patient morbidity and need for continued medical attention.
Authors and Affiliations
Deepti N. Rao, Gopal Subbaiah, Seshagiri Rao K
Keywords
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- EP ID EP411621
- DOI 10.14260/jemds/2018/310
- Views 84
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