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Abstract
The extent of thyroidectomy in benign thyroid diseases is still a matter of
controverse and shows a large spectrum of management strategies.
The aim of all these procedures is to perform the most effective treatment
with the least complications, without the incidence of recurrence and without
the need for secondary surgical intervention which will be very difficult and
hazardous due to disturbed anatomy and adhesions with a higher incidence
of RLN injury and/or hypoparathyroidism.
This work aimed to compare the safety, efficacy, incidence of complications
and surgical outcome in patients operated upon for benign thyroid diseases
applying total thyroidetomy and subtotal thyroidectomy discussing opinions
with and against applying both procedures in benign thyroid diseases.
This study points out the most important complication of total
thyroidectomy which are RLN injury and hypoparathyroidism comparing
their incidence to that
associated with subtotal thyroidectomy also this study points out the mostimportant complication of subtotal thyroidectomy ”recurrence” which is
absent in case of total thyroidectomy as recurrence takes the patient to the
risk of secondary surgical intervention which will be very difficult and
hazardous.
Our study comprised 140 patients with benign thyroid diseases.All patients had been subjected to full clinical assessment, routine laboratory
studies, thyroid profile, neck US, indirect laryngoscopy and FNAC and
thyroid scan when indicated and no patient was allowed to be operated upon
unless becomes adequately prepared and euthyroid.
Postoperative follow up for these patients revealed that the incidence of
transient RLN palsy was 1.3% in both groups while the incidence of
permanent RLN palsy was0% and the incidence of transient
hypoparathyroidism was 5.7%for the 1st group and4.2% for the 2nd group
while no cases suffered from permanent hypoparathyroidism and 7
histologic surprise (malignancy) in our study3 for the 1st group and 4 for the
2nd group.
This study points out that the incidence of complications is nearly the same
as the international literature incidence of complications associated with
total and subtotal thyroidectomy
At the end this study emphasized that there is an obvious
decrease in the incidence of complications associated with total
thyroidectomy especially with increasing experience and refinement of
surgical technique.
from this work, we concluded that:
1) Total thyroidectomy is recommended as the routine procedure of
choice in benign thyroid diseases because it avoids leaving residual
unhealthy thyroid tissue liable for recurrence with or without
superimposed malignancy and
2) the risk of complications in the secondary surgical intervention is
extremely higher.