Total thyroidectomy for benign thyroid disease: is it really worthwhile?

OBJECTIVE: To compare the outcomes of bilateral subtotal (BST) versus total thyroidectomy (TT) for benign bilateral thyroid disease (BBTD). BACKGROUND: The extent of thyroid resection in benign goiter is controversial. Potential advantages of TT over BST may include: one-stage removal of incidental thyroid cancer, and a lower risk for goiter recurrence. However, these potential advantages should outweigh the risk of morbidity. METHODS: A retrospective cohort study was conducted of 8032 patients with BBTD operated in a single institution. Patients in Group A underwent BST (1999-2004, n = 5214; follow-up 72.3 ± 12.4 months), whereas patients in Group B underwent TT (2005-2009, n = 2918; follow-up 36.3 ± 10.6 months). Data were collected prospectively. The analysis included: prevalence of incidental thyroid cancer, recurrent goiter, need for completion thyroidectomy, and morbidity. RESULTS: Incidental thyroid cancer was found in 406 (5.00%) patients. One hundred twelve (2.15%) BST versus 3 (0.10%) TT patients required completion thyroidectomy (P < 0.001). Recurrent goiter was diagnosed in 364 (6.99%) BST patients and 165 (45.33%) required reoperation versus 0% after TT (P < 0.001). The prevalence of transient and permanent hypoparathyroidism was 2.70% and 0.15% versus 13.12% and 0.10% (BST vs. TT, P < 0.001 and P = 0.65, respectively). The prevalence of temporary and permanent RLN injury was 2.30% and 0.71% versus 2.60% versus 0.69% (BST vs. TT, respectively; nonsignificant). CONCLUSIONS: Compared to TT, BST resulted in a significantly higher rate of completion thyroidectomy for incidentally diagnosed thyroid cancer and need for redo surgery for recurrent goiter. The extent of surgical resection had no significant impact on the prevalence of permanent complications. REGISTRATION NUMBER: NCT01273714 (http://www.clinicaltrials.gov).