Simple Multinodular Goiter: A Ten – Year Experience in a Developing Country

Background: The normal thyroid gland is a fairly homogenous structure, but nodules often formed within its substance these nodule may be the growth and fusion of localized colloid – filled follicles, or discrete adenomas, or cyst. The terms adenomatous goiter, simple multi nodular goiter, non toxic nodular goiter, and colloid nodular goiter are used interchangeably as descriptive terms when a multi nodular goiter is found. This study reviewed our ten year experience with management of multi nodular goiter in a developing country Patient and Methods: The study reviewed all patients diagnosed and managed with simple multi nodular goiter between January 2005 and December 20014 . All patients had open subtotal thyroidectomy. Surgery was under general anesthesia with endotracheal intubation. Prophylactic antibiotic (ceftriaxone) was given at induction. All patients had subtotal thyroidectomy with post operative drain placed within thyroid bed and removed on the second postoperative day. Skin flaps were approximated using vircryl 2/0 suture to reduce the dead space while the skin was closed using Mitchell’s clips. Results: A total of 248 patients were analyzed, with a female to male ratio of 6.75:1. Age ranged from 16 to 76 years with a mean of 42.86years and SD of 11.23. The peak age group was 30 – 39 years accounting for 30.65%, with 82.77% of the patients below the age of 50 years. The indications for surgery were cosmetics in 85.08%, and pressure symptoms in 30.65%. . The histology revealed multi nodular colloid goiter in 76.21%, and multi nodular colloid with adenomatous hyperplasia in 23.79%. Associated findings were cystic degeneration in 9.27%, and foci of incidental follicular carcinoma in 1.21%. The postoperative complications were transient hypocalcaemia in 7.66%, respiratory obstruction in 10.89% (laryngeal edema in 8.47%, hematoma in 1.61%, and transient recurrent laryngeal nerve injury in 0.81%). Conclusion: Simple multi nodular goiter is common and patient present late with large goiters posing surgical challenges. Subtotal thyroidectomy is still a formidable option in the management of multi nodular goiter especially in developing countries where thyroxine is not readily available or expensive.