COMPARATIVE STUDY - OUTCOME OF SUBTOTAL THYROIDECTOMY VS TOTAL THYROIDECTOMY FOR MULTINODULAR GOITRE

BACKGROUND Multinodular Goitre (MNG) comprises a spectrum of clinical features, consists of multiple hyper-functioning nodules scattered throughout an enlarged thyroid gland that also may contain non-functioning nodules. Medical care or radioactive iodine may be used for larger goitres; but the best choice of MNG treatment is surgery, especially in cosmetic problem, compressive symptom, toxicity and suspicion of malignancy. There are several methods for thyroid gland operation such as Subtotal Thyroidectomy (STT), Near Total Thyroidectomy (NTT), hemi-thyroidectomy plus subtotal resection (Dunhill procedure) and Total Thyroidectomy (TT). But the surgical method of benign thyroid disease treatment is still controversial. AIMS AND OBJECTIVES To assess the clinical profile of multinodular goitre and to assess and compare the outcome of subtotal and total thyroidectomy for the patients of multinodular goitre. MATERIALS AND METHODS A prospective interventional study was done at Vinayaka Mission's Kirupananda Variyar Medical College and Hospital during the period of August 2013-August 2015. A non-random purposive sampling was done and 40 cases were selected as the study population. All the patients were diagnosed as multinodular goitre by doing FNAC. Patients with thyroid malignancy were excluded from the study. All patients were rendered euthyroid before surgery. Among 40 patients 20 patients had undergone subtotal thyroidectomy and the remaining 20 patients had undergone total thyroidectomy. All the patients were followed up over a period of 1 year. RESULTS The mean thyroid and calcium levels were almost in the normal limits for all the patients, both in the preoperative phase as well as in the postoperative period. Among the patients who had undergone total thyroidectomy only one patient had developed the complications of recurrent laryngeal nerve injury, superior laryngeal nerve injury, hypothyroidism and hypoparathyroidism, whereas among the patients who underwent subtotal thyroidectomy none of these complications were seen; 3 patients out of 20 who had undergone subtotal thyroidectomy had developed recurrence at the end of 1 year, whereas there was no evidence of recurrence among the patients who had undergone total thyroidectomy and the difference was found to be statistically significant (p<.0001). CONCLUSION Despite the higher rate of post-operative complications, total thyroidectomy will be more beneficial in the surgical treatment of benign thyroid disorders.