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Original Article |

The Advantage of Total Thyroidectomy to Avoid Reoperation for Incidental Thyroid Cancer in Multinodular Goiter FREE

Yasemin Giles, MD; Harika Boztepe, MD; Tarik Terzioğlu, MD; Serdar Tezelman, MD
[+] Author Affiliations

From the Departments of Surgery (Drs Giles, Terzio[[gbreve]]lu, and Tezelman) and Endocrinology (Dr Boztepe), Istanbul Medical Faculty, Istanbul, Turkey.


Arch Surg. 2004;139(2):179-182. doi:10.1001/archsurg.139.2.179.
Text Size: A A A
Published online

Hypothesis  To investigate the impact of total thyroidectomy on the rate of completion thyroidectomy for incidentally found thyroid cancer in euthyroid multinodular goiter.

Design  A randomized, prospective clinical trial.

Setting  A tertiary referral center.

Patients  Patients with euthyroid multinodular goiter without any preoperative suspicion of malignancy, history of familial thyroid cancer, or previous exposure to radiation were randomized (according to a random table) to total or near-total thyroidectomy leaving no remnant tissue or less than 1 g (group 1; n = 109) or bilateral subtotal thyroidectomy leaving 5 g or more of remnant tissue (group 2; n = 109). Patients with preoperative or perioperative suspicion of malignancy were excluded.

Main Outcome Measures  We compared the complication rates and the incidence of thyroid cancer requiring radioactive iodine ablation and completion thyroidectomy between groups.

Results  There were no permanent complications. The rates of temporary unilateral vocal cord dysfunction and hypoparathyroidism showed no significant difference between groups 1 and 2 (0.9% vs 0.9% and 1.8% vs 0.9%, respectively; P>.05). Papillary cancer was found in 10 group 1 patients (9.2%) and 8 group 2 patients (7.3%) (P = .80). Of the 9 patients requiring radioactive iodine ablation, reoperation was avoided in 5 group 1 patients; the remaining 4 group 2 patients underwent completion thyroidectomy (P = .007).

Conclusion  We recommend total or near-total thyroidectomy in multinodular goiter to eliminate the necessity for early completion thyroidectomy in case of a final diagnosis of thyroid cancer.

Total thyroidectomy is the procedure of choice in patients with thyroid cancer, Basedow or Graves disease, and toxic multinodular goiter. In recent years, total thyroidectomy has emerged as a surgical option to treat patients with multinodular goiter, especially in endemic iodine-deficient regions.111 Multinodular hyperplasia frequently involves the whole gland in endemic regions, and there is no normal tissue to leave behind. The rate of recurrence is high after subtotal resections for multinodular goiter in long-term follow-up, despite postoperative thyroid hormone supplementation.2,6,8,1215 A considerable number of patients undergoing primary treatment with subtotal resection need reoperation for recurrence, which has a higher rate of complication compared with the primary procedures.6,1620 The incidence of thyroid cancer varies from 7.5% to 13% in multinodular goiter.2123 The presence of multiple nodules decreases the diagnostic value of fine-needle aspiration biopsy, and thyroid cancer is frequently an incidental postoperative histological finding in multinodular goiter. In such patients treated with subtotal thyroidectomy, completion thyroidectomy might be necessary.

The aim of this study was to investigate whether total or near-total thyroidectomy decreased the rate of completion thyroidectomy for incidentally diagnosed thyroid cancer in multinodular goiter in an endemic iodine-deficiency region.

From September 1, 2001, to December 31, 2002, we undertook a prospective study to compare the rates of completion thyroidectomy for incidentally found thyroid cancer after total or near-total and subtotal thyroidectomy in multinodular goiter. Two hundred eighteen patients with multinodular goiter were included in the study. All patients were euthyroid and had no history of hyperthyroidism, radiation exposure, or familial thyroid cancer. Thyroid scanning and ultrasonography revealed multinodular hyperplasia of the thyroid gland in all patients. Patients were selected according to the number on the random table for 2 different extensions of surgical procedures. The total amount of remnant thyroid tissue was intended to be none or less than 1 g in group 1 and 5 g or more in group 2. Near-total thyroidectomy was performed by the capsular dissection method, leaving less than 1 g of remnant tissue. The amount of remnant tissue was estimated as 1 cm3 equals 1 g. Any patient with preoperative or perioperative suspicion of malignancy was excluded. Postoperative complications, thyrotropin (TSH) values, and the incidence of thyroid cancer were assessed in both groups. We investigated whether there was a significant difference in the rate of thyroid cancer requiring radioactive iodine (RAI) ablation and completion thyroidectomy between groups. Histological criteria for RAI therapy included tumor size greater than 1.5 cm, any size of tumor with thyroid capsule or extrathyroidal invasion, or multicentricity (≥3 tumor foci). The departments of general surgery and endocrinology collaborate to maintain the treatment of patients with thyroid cancer at Istanbul Medical Faculty, Istanbul, Turkey. The histological criteria for postoperative RAI ablation (100 mCi [3700 MBq]) was established as a result of this cooperative work and has been our policy for the past 2 decades. The TSH values were required to be more than 30 mIU/L to refer the patient to RAI ablation therapy. Patients who were treated with RAI were verified to have undetectable levels of serum thyroglobulin and no uptake at the thyroid bed or distant sites by iodine I131 (131I)–labeled thyroid and whole body scans after the treatment. These patients received suppressive doses of thyroid hormone, and serum thyroglobulin assays were performed at 6-month intervals. Thyroid and whole body scans labeled with 131I were repeated if serum thyroglobulin levels increased during further follow-up. Patients with noninvasive microcarcinoma who did not receive RAI ablation received suppressive doses of thyroid hormone after thyroidectomy. The follow-up schedule of these patients was similar to that of patients undergoing operation for benign goiter (neck examination and determination of serum TSH values every 6 months for the initial 2 years and then annually). Linear correlation, paired t test, and Fisher exact test were used for statistical analysis, and P<.05 was accepted as significant. The ethics committee of our institution approved of the study, and informed consent was obtained from all patients participating in the trial.

PREOPERATIVE FINDINGS

The mean ± SD age was found to be significantly higher in group 1 (50.3 ± 12.5 years) compared with group 2 (45.7 ± 12.1 years) (P = .02). The male-female ratio was 15:94 and 17:92 in groups 1 and 2, respectively (P = .70). A coexistent dominant nodule was found in 39 patients (17.9%), including 20 in group 1 and 19 in group 2.

PERIOPERATIVE FINDINGS

Total and near-total thyroidectomy was performed in 19 (17.4%) and 90 (82.6%) patients, respectively, in group 1. Bilateral subtotal thyroidectomy was performed in all 109 patients in group 2. The total amount of remnant tissue was estimated to be 5 g in 77 patients (70.6%), 6 g in 26 (23.9%), and 7 g in 6 (5.5%).

POSTOPERATIVE FINDINGS

Permanent hypoparathyroidism and vocal cord paralysis were not encountered in either group of patients. The rate of temporary unilateral vocal cord dysfunction was the same (0.9%) in both groups. Although not statistically significant, the incidence of temporary hypoparathyroidism was slightly higher in group 1 than in group 2 (1.8% vs 0.9%).

The mean ± SD value of the TSH value at the first postoperative month was significantly higher in group 1 compared with group 2 (45.3 ± 17.3 vs 11.5 ± 6.5 mIU/L) (P<.001). Papillary cancer was detected in 18 patients (8.2%), of whom 13 (72%) had papillary microcarcinoma (<1 cm). Of 39 patients with a coexistent dominant nodule, papillary cancer was found in only 1. This patient had a papillary microcarcinoma not originating from the dominant nodule and without local invasion or multicentricity. The incidence of papillary cancer was 9.2% (10/109) in group 1 and 7.3% (8/109) in group 2 (P = .80) (Table 1). Of 18 patients with papillary cancer, 9 (50%) had microcarcinoma with no local invasion or multicentricity. These patients were scheduled for follow-up only. The remaining 9 patients were found to have the histological criteria for RAI ablation (Table 1). Of these 9 patients, 5 were in group 1 and 4 in group 2. Five patients in group 1 received RAI ablative therapy directly. The TSH values of the 4 patients in group 2 were below 30 mIU/L, and these patients underwent completion thyroidectomy before ablative therapy. Thus, of 9 patients requiring RAI ablation, reoperation was avoided in 5 group 1 patients; however, 4 patients in group 2 underwent completion thyroidectomy (P = .007). There were no complications after completion thyroidectomy in those 4 patients.

Table Graphic Jump LocationThe Histological Feature of Papillary Cancer in Groups 1 and 2

In the present study, the incidence of incidental thyroid cancer was found to be 8.2% in patients undergoing operation for multinodular euthyroid goiter without any preoperative or perioperative suspicion of malignancy. We documented that performance of total or near-total thyroidectomy instead of subtotal resection as the primary procedure significantly reduced the rate of completion thyroidectomy for incidentally found thyroid cancer in multinodular goiter. Total or near-total thyroidectomy was associated with a slightly higher risk for temporary hypoparathyroidism, but this was not statistically significant.

The goal of surgical treatment in thyroid disease should be to eliminate the disease with low complication rates and to minimize the necessity for reoperative procedures. Reoperations are undertaken for postoperative histological evidence of thyroid cancer or recurrent goiter during further follow-up and are associated with higher complication rates compared with primary procedures.1,620,24,25

Multinodular goiter is the most common indication for thyroidectomy in endemic iodine-deficient regions. Preoperative evaluation for thyroid cancer by means of fine-needle aspiration biopsy is difficult in multinodular goiter owing to the presence of multiple nodules, and thyroid cancer is frequently an unexpected postoperative finding. The risk for malignancy was thought to be lower in multinodular goiter compared with solitary cold nodules. Recent studies, however, documented that this was not the case. The incidence of thyroid cancer showed no significant difference in solitary cold nodules and in cold nodules of multinodular goiter, and patients with thyroid cancer frequently presented with multinodular goiter.21,26,27 Reoperation should be performed in patients with incidentally found thyroid cancer if the histological criteria mandate RAI ablation and there is a large volume of thyroid remnant. In the present study, of 9 patients scheduled for RAI ablation, tumor size was smaller than 1.5 cm in 7. Although these patients were considered to be at low risk according to MACIS (Metastasis, Age, Curative resection, Invasion, Size) classification, histological examination revealed multifocality, thyroid capsule invasion, or extrathyroidial spread. Low-risk patients have a favorable prognosis, but multifocality, thyroid capsule invasion, and extrathyroidial invasion were shown to adversely affect the prognosis.2831 Baudin et al31 analyzed the data of 281 patients with thyroid microcarcinoma (<1 cm) and documented that patients with more than 1 tumor focus had a significantly higher rate of recurrence compared with those with unifocal tumors, and multifocality significantly influenced the prevalence of RAI treatment. The RAI ablation was found to be an important factor in prolonging the disease-free interval and survival in patients with well-diffferentiated thyroid cancer, even low-risk patients.32 In Turkey, a considerable number of patients undergoing operation for thyroid cancer adher to the postoperative follow-up program; however, patient noncompliance still constitutes a major problem, and some patients undergoing surgery for thyroid cancer delay seeking medical help until the development of serious complications. We prefer to take unfavorable histological findings into account when deciding on RAI treatment, despite the low-risk score. The preferred TSH level is higher than 30 mIU/L for effective RAI ablation.33 Despite interfering with proper RAI ablation, remnant tissue may contain residual carcinoma in 11% to 53% of patients who undergo subtotal thyroidectomy with no difference in the frequency in high- and low-risk patients.17,3439 Thyroid cancer might be detected in approximately 10% of thyroidectomy specimens of recurrent goiter, although the preceding operations were performed for benign goiter.40 Menegaux et al40 documented that 20% of such patients had multifocal cancer, lymph node metastasis, or distant metastasis.

Subtotal resections (unilateral or bilateral) have been the preferred surgical treatment for multinodular goiter.6,23,41 A conservative surgical approach followed by thyroid hormone supplementation has been claimed to efficiently prevent recurrence.41,42 Reoperation rate for recurrence was low (2%) when all nodules were removed during thyroidectomy, but multinodular goiter was documented to be a risk factor for recurrence.42 Anderson et al41 found that postoperative thyroid hormone therapy reduced the rate of recurrence, but that limited unilateral procedures were associated with a high rate of recurrence. Recent studies, however, have documented that the recurrence rate after subtotal resections is high, and that the preventive effect of postoperative thyroxine treatment is highly questionable.1215,43,44 The incidence of recurrence has been directly related to a long postoperative follow-up and to large amounts of remnant tissue.13,41,4345Most of the recurrences developed 10 to 20 years after the previous surgery, although some authors recommend 30 years of follow-up to determine the actual outcome.3,6,13,41,42 Subtotal thyroidectomy in multinodular goiter has resulted in reoperation for recurrence in 13% to 20% of patients, reaching a peak incidence 13 years after the primary operation.6

The performance of total thyroidectomy in multinodular disease has been reserved for exceptionally large goiters. Opponents of total thyroidectomy claim that the procedure is not justified in multinodular disease, as the risk for malignancy is low but associated complication rates are high.46,47 It has been documented that total thyroidectomy can be performed safely in benign nodular goiter, but that reoperations carry greater risk.5,6,8,9,16 In addition, the relative risk for permanent complications has been found to be higher in reoperations for recurrent disease than in primary operations with extensive resection.48

The incidence of thyroid cancer in multinodular goiter without any previous suspicion of malignancy was found to be 8.2%. Subtotal thyroidectomy resulted in a significantly higher rate of completion thyroidectomy for incidentally diagnosed thyroid cancer compared with total or near-total thyroidectomy. No permanent complications occurred, and the extent of surgical resection had no significant effect on the rate of temporary complications. We recommend total or near-total thyroidectomy in multinodular goiter to eliminate the need for completion thyroidectomy in case of a final diagnosis of thyroid cancer.

Corresponding author and reprints: Yasemin Giles, MD, Istanbul Tip Fakültesi, Genel Cerrahi ABD, Çapa, Topkapi, Istanbul, Turkey 34390 (e-mail: ygiles@ixir.com).

Accepted for publication August 7, 2003.

Siragusa  GLanzara  PDi Pace  G Subtotal thyroidectomy or total thyroidectomy in the treatment of benign thyroid disease: our experience [in Italian]. Minerva Chir. 1998;53233- 238
PubMed
Zaraca  FDi Paola  MGossetti  F  et al.  Benign thyroid disease: 20-year experience in surgical therapy [in Italian]. Chir Ital. 2000;5241- 47
PubMed
Visset  JLumingu  KLe Bodic  MFPaineau  JLetessier  E Total thyroidectomy to prevent recurrence of benign thyroid goiter [in French]. Chirurgie. 1991;11737- 40
PubMed
Peix  JLVan Box Som  P Role of total thyroidectomy in the treatment of benign thyroid diseases [in French]. Ann Endocrinol (Paris). 1996;57502- 507
PubMed
Reeve  TSDelbribge  LCohen  ACrummer  P Total thyroidectomy: the preferred option for multinodular goiter. Ann Surg. 1987;206782- 786
PubMed Link to Article
Delbridge  LGuinea  AIReeve  TS Total thyroidectomy for bilateral benign multinodular goiter: effect of changing practice. Arch Surg. 1999;1341389- 1393
PubMed Link to Article
Jacobs  JKAland Jr  JWBallinger  JF Total thyroidectomy: a review of 213 patients. Ann Surg. 1983;197542- 549
PubMed Link to Article
Pappalardo  GGuadalaxara  AFrattaroli  FMIllomei  GFalaschi  P Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports. Eur J Surg. 1998;164501- 506
PubMed Link to Article
Liu  QDjuricin  GPrinz  RA Total thyroidectomy for benign thyroid disease. Surgery. 1998;1232- 7
PubMed Link to Article
Mishra  AAgarwal  AAgarwal  GMishra  SK Total thyroidectomy in benign thyroid disorders in an endemic region. World J Surg. 2001;25307- 310
PubMed Link to Article
Gough  IRWilkinson  D Total thyroidectomy for management of thyroid disease. World J Surg. 2000;24962- 965
PubMed Link to Article
Berglund  JBondesson  LChristensen  SBLarsson  ASTibblin  S Indications for thyroxine therapy after surgery for nontoxic benign goitre. Acta Chir Scand. 1990;156433- 438
PubMed
Rojdmark  JJarhult  J High long term recurrence rate after subtotal thyroidectomy for nodular goitre. Eur J Surg. 1995;161725- 727
PubMed
Geerdsen  JPFrolund  L Thyroid function after surgical treatment of nontoxic goitre: a randomized study of postoperative thyroxine administration. Acta Med Scand. 1986;220341- 345
PubMed Link to Article
Geerdsen  JPFrolund  L Recurrence of nontoxic goitre with and without postoperative thyroxine medication. Clin Endocrinol (Oxf). 1984;21529- 533
PubMed Link to Article
Reeve  TSDelbridge  LBrady  PCrummer  PSmyth  C Secondary thyroidectomy: a twenty-year experience. World J Surg. 1988;12449- 453
PubMed Link to Article
Pezzullo  LDelrio  PLosito  NSCaraco  CMozzillo  N Post-operative complications after completion thyroidectomy for differentiated thyroid cancer. Eur J Surg Oncol. 1997;23215- 218
PubMed Link to Article
Bergamaschi  RBecouarn  GRonceray  JArnaud  JP Morbidity of thyroid surgery. Am J Surg. 1998;17671- 75
PubMed Link to Article
Wilson  DBStaren  EDPrinz  RA Thyroid reoperations: indications and risks. Am Surg. 1998;64674- 678
PubMed
Beahrs  OHVandertoll  DJ Complications of secondary thyroidectomy. Surg Gynecol Obstet. 1963;117535- 539
PubMed
McCall  AJarosz  HLawrence  AMPaloyan  E The incidence of thyroid carcinoma in solitary cold nodules and in multinodular goiters. Surgery. 1986;1001128- 1132
PubMed
Koh  KBHChang  KW Carcinoma in multinodular goitre. Br J Surg. 1992;79266- 267
PubMed Link to Article
Lopez  LHHerrera  MFGamino  R  et al.  Surgical treatment of multinodular goiter at the Instituto Nacional de nutricion Salvador Zubiran [in Spanish]. Rev Invest Clin. 1997;49105- 109
PubMed
Chao  TCJeng  LBLin  JDChen  MF Reoperative thyroid surgery. World J Surg. 1997;21644- 647
PubMed Link to Article
Calabro  SAuguste  LJAttie  JN Morbidity of completion thyroidectomy for initially misdiagnosed thyroid carcinoma. Head Neck Surg. 1988;10235- 238
PubMed
Sachmechi  IMiller  EVaratharajah  R  et al.  Thyroid carcinoma in single cold nodules and in cold nodules of multinodular goiters. Endocr Pract. 2000;65- 7
PubMed Link to Article
Mato  AGippini  APeino  RGayosso  PUriel  B Differentiated carcinoma of the thyroid gland in an area of endemic goiter: clinical study and prognostic correlation [in Spanish]. An Med Interna. 1996;13537- 540
PubMed
Hay  IDBergstralh  EJGoellner  JREbersold  JRGrant  CS Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery. 1993;1141050- 1058
PubMed
Mazzaferri  EL Papillary thyroid carcinoma: factors influencing prognosis and current therapy. Semin Oncol. 1987;14315- 322[Published Correction Appears In Semin Oncol. 1988;15(3):x].
PubMed
Shah  JPLoree  TRDharker  DStrong  EWBegg  CVlamis  V Prognostic factors in differentiated carcinoma of the thyroid gland. Am J Surg. 1992;164658- 661
PubMed Link to Article
Baudin  ETravagli  JPRopers  J  et al.  Microcarcinoma of the thyroid gland: the Gustave-Roussy Institute experience. Cancer. 1998;83553- 559
PubMed Link to Article
Samaan  NASchultz  PNHickey  RC  et al.  The results of various modalities of treatment of well differentiated thyroid carcinoma: a retrospective review of 1599 patients. J Clin Endocrinol Metab. 1992;75714- 720
PubMed
Logue  JPTsang  RWBrierley  JDSimpson  WJ Radioiodine ablation of residual tissue in thyroid cancer: relationship between administered activity, neck uptake and outcome. Br J Radiol. 1994;671127- 1131
PubMed Link to Article
Rodriguez-Cuevas  SLabastida-Almendaro  SBriceno-Ancona  NGonzalez-Rodriguez  D Reintervention to complete the surgical treatment of thyroid cancer: indications and histopathological findings [in Spanish]. Gac Med Mex. 1998;134677- 683
PubMed
Wax  MKBriant  DR Completion thyroidectomy in the management of well-differentiated thyroid carcinoma. Otolaryngol Head Neck Surg. 1992;10763- 68
PubMed
Pacini  FElisei  RCapezzone  M  et al.  Contralateral papillary thyroid cancer is frequent at completion thyroidectomy with no difference in low- and high-risk patients. Thyroid. 2001;11877- 881
PubMed Link to Article
Sarda  AKKapur  MM Thyroid carcinoma: a report of 206 cases from an area with endemic goitre. Acta Oncol. 1990;29863- 867
PubMed Link to Article
Alzahrani  ASMandil  ALChaudhary  MAAhmed  MMohammed  GE Frequency and predictive factors of malignancy in residual thyroid tissue and cervical lymph nodes after partial thyroidectomy for differentiated thyroid cancer. Surgery. 2002;131443- 449
PubMed Link to Article
Machens  AHinze  RLautenschlager  CThomusch  ODralle  H Prophylactic completion thyroidectomy for differentiated thyroid carcinoma: prediction of extrathyroidal soft tissue infiltrates. Thyroid. 2001;11381- 384
PubMed Link to Article
Menegaux  FTurpin  GDahman  M  et al.  Secondary thyroidectomy in patients with prior thyroid surgery for benign disease: a study of 203 cases. Surgery. 1999;126479- 483
PubMed Link to Article
Anderson  PEHurley  PRRosswick  P Conservative treatment and long term prophylactic thyroxine in the prevention of recurrence of multinodular goiter. Surg Gynecol Obstet. 1990;171309- 314
PubMed
Kraimps  JLMarechaud  RGineste  D  et al.  Analysis and prevention of recurrent goiter. Surg Gynecol Obstet. 1993;176319- 322
PubMed
Piraneo  SVitri  PGalimberti  ASalvaggio  ABastagli  A Ultrasonographic surveillance after surgery for euthyroid goitre in patients treated or not with thyroxine. Eur J Surg. 1997;16321- 26
PubMed
Piraneo  SVitri  PGalimberti  AGuzzetti  SSalvaggio  ABastagl  A Recurrence of goiter after operation in euthyroid patients. Eur J Surg. 1994;160351- 356
PubMed
Zelmanovitz  TZelmanovitz  FGenro  SGus  Pde Azevedo  MJGross  JL Analysis of the factors associated with the recurrence of postthyroidectomy goiter[in Portuguese]. Rev Assoc Med Bras. 1995;4186- 10
PubMed
Gould  EAHirsch  EBrecher  I Complications arising in the course of thyroidectomy. Arch Surg. 1965;9081- 85
PubMed Link to Article
Foster Jr  RS Morbidity and mortality after thryoidectomy. Surg Gynecol Obstet. 1978;146423- 429
PubMed
Thomusch  OMachens  ASekulla  C  et al.  Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg. 2000;241335- 1341
PubMed Link to Article

Figures

Tables

Table Graphic Jump LocationThe Histological Feature of Papillary Cancer in Groups 1 and 2

References

Siragusa  GLanzara  PDi Pace  G Subtotal thyroidectomy or total thyroidectomy in the treatment of benign thyroid disease: our experience [in Italian]. Minerva Chir. 1998;53233- 238
PubMed
Zaraca  FDi Paola  MGossetti  F  et al.  Benign thyroid disease: 20-year experience in surgical therapy [in Italian]. Chir Ital. 2000;5241- 47
PubMed
Visset  JLumingu  KLe Bodic  MFPaineau  JLetessier  E Total thyroidectomy to prevent recurrence of benign thyroid goiter [in French]. Chirurgie. 1991;11737- 40
PubMed
Peix  JLVan Box Som  P Role of total thyroidectomy in the treatment of benign thyroid diseases [in French]. Ann Endocrinol (Paris). 1996;57502- 507
PubMed
Reeve  TSDelbribge  LCohen  ACrummer  P Total thyroidectomy: the preferred option for multinodular goiter. Ann Surg. 1987;206782- 786
PubMed Link to Article
Delbridge  LGuinea  AIReeve  TS Total thyroidectomy for bilateral benign multinodular goiter: effect of changing practice. Arch Surg. 1999;1341389- 1393
PubMed Link to Article
Jacobs  JKAland Jr  JWBallinger  JF Total thyroidectomy: a review of 213 patients. Ann Surg. 1983;197542- 549
PubMed Link to Article
Pappalardo  GGuadalaxara  AFrattaroli  FMIllomei  GFalaschi  P Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports. Eur J Surg. 1998;164501- 506
PubMed Link to Article
Liu  QDjuricin  GPrinz  RA Total thyroidectomy for benign thyroid disease. Surgery. 1998;1232- 7
PubMed Link to Article
Mishra  AAgarwal  AAgarwal  GMishra  SK Total thyroidectomy in benign thyroid disorders in an endemic region. World J Surg. 2001;25307- 310
PubMed Link to Article
Gough  IRWilkinson  D Total thyroidectomy for management of thyroid disease. World J Surg. 2000;24962- 965
PubMed Link to Article
Berglund  JBondesson  LChristensen  SBLarsson  ASTibblin  S Indications for thyroxine therapy after surgery for nontoxic benign goitre. Acta Chir Scand. 1990;156433- 438
PubMed
Rojdmark  JJarhult  J High long term recurrence rate after subtotal thyroidectomy for nodular goitre. Eur J Surg. 1995;161725- 727
PubMed
Geerdsen  JPFrolund  L Thyroid function after surgical treatment of nontoxic goitre: a randomized study of postoperative thyroxine administration. Acta Med Scand. 1986;220341- 345
PubMed Link to Article
Geerdsen  JPFrolund  L Recurrence of nontoxic goitre with and without postoperative thyroxine medication. Clin Endocrinol (Oxf). 1984;21529- 533
PubMed Link to Article
Reeve  TSDelbridge  LBrady  PCrummer  PSmyth  C Secondary thyroidectomy: a twenty-year experience. World J Surg. 1988;12449- 453
PubMed Link to Article
Pezzullo  LDelrio  PLosito  NSCaraco  CMozzillo  N Post-operative complications after completion thyroidectomy for differentiated thyroid cancer. Eur J Surg Oncol. 1997;23215- 218
PubMed Link to Article
Bergamaschi  RBecouarn  GRonceray  JArnaud  JP Morbidity of thyroid surgery. Am J Surg. 1998;17671- 75
PubMed Link to Article
Wilson  DBStaren  EDPrinz  RA Thyroid reoperations: indications and risks. Am Surg. 1998;64674- 678
PubMed
Beahrs  OHVandertoll  DJ Complications of secondary thyroidectomy. Surg Gynecol Obstet. 1963;117535- 539
PubMed
McCall  AJarosz  HLawrence  AMPaloyan  E The incidence of thyroid carcinoma in solitary cold nodules and in multinodular goiters. Surgery. 1986;1001128- 1132
PubMed
Koh  KBHChang  KW Carcinoma in multinodular goitre. Br J Surg. 1992;79266- 267
PubMed Link to Article
Lopez  LHHerrera  MFGamino  R  et al.  Surgical treatment of multinodular goiter at the Instituto Nacional de nutricion Salvador Zubiran [in Spanish]. Rev Invest Clin. 1997;49105- 109
PubMed
Chao  TCJeng  LBLin  JDChen  MF Reoperative thyroid surgery. World J Surg. 1997;21644- 647
PubMed Link to Article
Calabro  SAuguste  LJAttie  JN Morbidity of completion thyroidectomy for initially misdiagnosed thyroid carcinoma. Head Neck Surg. 1988;10235- 238
PubMed
Sachmechi  IMiller  EVaratharajah  R  et al.  Thyroid carcinoma in single cold nodules and in cold nodules of multinodular goiters. Endocr Pract. 2000;65- 7
PubMed Link to Article
Mato  AGippini  APeino  RGayosso  PUriel  B Differentiated carcinoma of the thyroid gland in an area of endemic goiter: clinical study and prognostic correlation [in Spanish]. An Med Interna. 1996;13537- 540
PubMed
Hay  IDBergstralh  EJGoellner  JREbersold  JRGrant  CS Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery. 1993;1141050- 1058
PubMed
Mazzaferri  EL Papillary thyroid carcinoma: factors influencing prognosis and current therapy. Semin Oncol. 1987;14315- 322[Published Correction Appears In Semin Oncol. 1988;15(3):x].
PubMed
Shah  JPLoree  TRDharker  DStrong  EWBegg  CVlamis  V Prognostic factors in differentiated carcinoma of the thyroid gland. Am J Surg. 1992;164658- 661
PubMed Link to Article
Baudin  ETravagli  JPRopers  J  et al.  Microcarcinoma of the thyroid gland: the Gustave-Roussy Institute experience. Cancer. 1998;83553- 559
PubMed Link to Article
Samaan  NASchultz  PNHickey  RC  et al.  The results of various modalities of treatment of well differentiated thyroid carcinoma: a retrospective review of 1599 patients. J Clin Endocrinol Metab. 1992;75714- 720
PubMed
Logue  JPTsang  RWBrierley  JDSimpson  WJ Radioiodine ablation of residual tissue in thyroid cancer: relationship between administered activity, neck uptake and outcome. Br J Radiol. 1994;671127- 1131
PubMed Link to Article
Rodriguez-Cuevas  SLabastida-Almendaro  SBriceno-Ancona  NGonzalez-Rodriguez  D Reintervention to complete the surgical treatment of thyroid cancer: indications and histopathological findings [in Spanish]. Gac Med Mex. 1998;134677- 683
PubMed
Wax  MKBriant  DR Completion thyroidectomy in the management of well-differentiated thyroid carcinoma. Otolaryngol Head Neck Surg. 1992;10763- 68
PubMed
Pacini  FElisei  RCapezzone  M  et al.  Contralateral papillary thyroid cancer is frequent at completion thyroidectomy with no difference in low- and high-risk patients. Thyroid. 2001;11877- 881
PubMed Link to Article
Sarda  AKKapur  MM Thyroid carcinoma: a report of 206 cases from an area with endemic goitre. Acta Oncol. 1990;29863- 867
PubMed Link to Article
Alzahrani  ASMandil  ALChaudhary  MAAhmed  MMohammed  GE Frequency and predictive factors of malignancy in residual thyroid tissue and cervical lymph nodes after partial thyroidectomy for differentiated thyroid cancer. Surgery. 2002;131443- 449
PubMed Link to Article
Machens  AHinze  RLautenschlager  CThomusch  ODralle  H Prophylactic completion thyroidectomy for differentiated thyroid carcinoma: prediction of extrathyroidal soft tissue infiltrates. Thyroid. 2001;11381- 384
PubMed Link to Article
Menegaux  FTurpin  GDahman  M  et al.  Secondary thyroidectomy in patients with prior thyroid surgery for benign disease: a study of 203 cases. Surgery. 1999;126479- 483
PubMed Link to Article
Anderson  PEHurley  PRRosswick  P Conservative treatment and long term prophylactic thyroxine in the prevention of recurrence of multinodular goiter. Surg Gynecol Obstet. 1990;171309- 314
PubMed
Kraimps  JLMarechaud  RGineste  D  et al.  Analysis and prevention of recurrent goiter. Surg Gynecol Obstet. 1993;176319- 322
PubMed
Piraneo  SVitri  PGalimberti  ASalvaggio  ABastagli  A Ultrasonographic surveillance after surgery for euthyroid goitre in patients treated or not with thyroxine. Eur J Surg. 1997;16321- 26
PubMed
Piraneo  SVitri  PGalimberti  AGuzzetti  SSalvaggio  ABastagl  A Recurrence of goiter after operation in euthyroid patients. Eur J Surg. 1994;160351- 356
PubMed
Zelmanovitz  TZelmanovitz  FGenro  SGus  Pde Azevedo  MJGross  JL Analysis of the factors associated with the recurrence of postthyroidectomy goiter[in Portuguese]. Rev Assoc Med Bras. 1995;4186- 10
PubMed
Gould  EAHirsch  EBrecher  I Complications arising in the course of thyroidectomy. Arch Surg. 1965;9081- 85
PubMed Link to Article
Foster Jr  RS Morbidity and mortality after thryoidectomy. Surg Gynecol Obstet. 1978;146423- 429
PubMed
Thomusch  OMachens  ASekulla  C  et al.  Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg. 2000;241335- 1341
PubMed Link to Article

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