Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports.

Objective: To evaluate the outcome after total and subtotal thyroidectomy for the treatment of single and multinodular goitres in two comparable groups of patients.

Design: Prospective randomised study.

Setting: University hospital, Italy.

Subjects: 141 Patients operated on for benign goitre from 1975-85.

Interventions: 69 Patients were randomised to have total thyroidectomy and 72 subtotal thyroidectomy by standard techniques.

Main Outcome Measures: Temporary or permanent palsy of the recurrent laryngeal nerve, temporary or permanent hypoparathyroidism, recurrence of the goitre, and the incidence of iatrogenic injuries after completion thyroidectomy.

Results: Patients were followed up for a median of 14.5 years (range 10-21). After total thyroidectomy 2 patients (3%) developed temporary palsy of the recurrent laryngeal nerve but there were no permanent lesions; and 24 (35%) developed temporary and 2 (3%) permanent hypoparathyroidism. After subtotal thyroidectomy 2 (3%) developed temporary and 1 (1%) permanent palsy of the recurrent laryngeal nerve; and 13 (18%) developed temporary and 1 (1%) permanent hypoparathyroidism. In addition, there were 10 recurrent goitres (14%). After completion thyroidectomy (n = 9) there were 2 cases of temporary and 1 of permanent palsy of the recurrent laryngeal nerve, and 2 cases of temporary and 2 of permanent hypoparathyroidism.

Conclusion: Total thyroidectomy is the procedure of choice for the treatment of benign nodular goitre.