The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases.

BACKGROUND Total thyroidectomy is currently the preferred treatment for thyroid cancer, multinodular goitre and Graves disease; however, many surgeons choose not to perform total thyroidectomy to treat benign thyroid diseases owing to the associated risk of postoperative hypoparathyroidism and recurrent laryngeal nerve damage. We reviewed 932 total thyroidectomies performed for benign thyroid diseases when surgery was indicated. 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 benign thyroid diseases. METHODS A total of 932 patients underwent thyroidectomy between 1985 and 2005. We excluded patients with thyroid cancer or suspicion of thyroid malignancy. We evaluated indications for total thyroidectomy, cancer incidence, complication rates, local recurrence rate and long-term outcome after total thyroidectomy. RESULTS Diagnoses before surgery were multinodular goitre (n = 734, 78.8%), Graves disease (n = 166, 17.8%) and recurrent (after previous partial thyroidectomy) nodular goitre (n = 32, 3.4%). The incidence of permanent bilateral recurrent laryngeal nerve palsy was 0% and that of permanent unilateral recurrent laryngeal nerve palsy was 0.2%, whereas the incidence of temporary unilateral recurrent laryngeal nerve palsy was 1.3%. Permanent hypocalcemia occurred in 0.3% and overall temporary hypocalcemia occurred in 7.3% of patients. Hemorrhage requiring repeat surgery occurred in 0.2% of patients. There was no wound infection, and postoperative mortality was 0%. We observed no disease recurrences during a median follow-up of 9 (range 2-20) years. CONCLUSION Total thyroidectomy is safe and is associated with a low incidence of disabilities. Complication rates for recurrent laryngeal nerve palsy and hypoparathyroidism are similar to results of specialist endocrine surgery units. Furthermore, total thyroidectomy seems to be the optimal procedure, when surgery is indicated, for Graves disease and multinodular goitre, as total thyroidectomy has the advantages of immediate and permanent cure and no recurrences.