[Surgical treatment of solitary thyroid nodule]. / Il trattamento chirurgico del nodulo unico tiroideo.

ABSTRACT

In this report we examine the surgery of solitary thyroid nodules, outlining the operations performed and the diagnostic-instrumental procedures aimed at identifying the degree of malignancy of the lesion. If intraoperative cytological and histological examination of a nodule show that it is benign, we perform lobectomy. In a total of 400 cases, we performed 52 (13%) nodule resections, 276 (69%) hemithyroidectomies, and 72 (18%) extended resections comprising the isthmus and Laluette pyramid. Twenty-five patients (5%) were affected by differentiated cancers arising in the nodule. In this group, the carcinoma diagnosis, revealed by fine the needle aspiration and confirmed at the intraoperative examination, allowed us to perform a total thyroidectomy in a single session in 21 cases (84%); more specifically, total thyroidectomy only was performed in 14 (56%) cases, while in 7 cases (28%) a laterocervical lymph-node resection was also necessary due to the presence of lymph nodes of increased volume. We had three cases with lesions of the recurrent nerve (0.6%) and 30 with irritation of the superior laryngeal nerve (6%) which caused temporary hypoaesthesia of the larynx and hoarseness. Moreover, four patients (8%) presented temporary postoperative hypoparathyroidism. No instances of permanent hypoparathyroidism were observed. The report concludes by analysing a number of surgical techniques for the treatment of solitary thyroid nodules.