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Volume 14
Issue 3
Online publication date 2013-11-14
Title Total thyroidectomy for multinodular goiter - is it really an option in endemic region?
Author Kalin Vidinov, Manol Kalniev, Dimo Krastev, Ludmil Veltchev
Abstract
Bilateral multinodular goiter is the most common indications for surgery in endemic iodine-deficiency regions such as Bulgaria. Total thyroidectomy is currently the preferred treatment for thyroid cancer, for multinodular goiter. However many surgeons and endocrinologist still choose not to perform or recommend total thyroidectomy or lobectomy for bilateral or unilateral disease. We sought to assess whether the results support the hypothesis that total thyroidectomy is safe and can be considered as the optimal surgical approach for treating BMG in endemic region such as Bulgaria.

A total of 500 patients were included in this study. They underwent thyroid operation between 2004 and 2009. We excluded patients with thyroid cancer or suspicion of thyroid malignancy. We evaluated indications for total thyroidectomy, complication rates, local recurrence rate and long-term outcome after total thyroidectomy.
All patients had bilateral goiter diagnosed with ultrasound (n = 500). The incidence of permanent bilateral recurrent laryngeal nerve palsy was 0% and that of permanent unilateral recurrent laryngeal nerve palsy and permanent hypocalcaemia occurred was 0.8 - 1.2 %. Hemorrhage requiring repeat surgery occurred in 0.4-2 % of patients. There was no wound infection, and postoperative mortality was 0%. Total thyroidectomy is safe and is associated with a low incidence of disabilities. Ttotal thyroidectomy has the advantages of immediate and permanent cure and no recurrences.

Citation
References
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Keywords Bilateral multinodular goiter, total thyroidectomy, subtotal thyroidectomy, endemic region
DOI http://dx.doi.org/10.15208/mhsj.2013.24
Pages 140-143
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