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TOTAL THYROIDECTOMY IN THE TREATMENT OF BENIGN PATHOLOGY

Keywords: BENIGN PATHOLOGY OF THYROID , HIDDEN CARCINOMAS , MULTINODULAR GOITER , TOTAL THYROIDECTOMY , RECURRENT NERVE LESIONS , POSTOPERATIVE HYPOCALCEMIA

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Abstract:

Total thyroidectomy or subtotal thyroidectomy performed in benign pathology of thyroid? Methods: To answer this question we performed a retrospective study on 1103 cases with this pathology: 1082 cases first intervention and 51 cases for relapse pathology. Preoperative diagnosis included: evaluation of the functionality of the thyroid by lab tests, endocrinology exam, ORL exam, anhéstesiologique exam, chest radiograph, CT/MRI neck and thorax, ultrasound, scintigraphy, fine-needle aspiration cytologic diagnoses. Results: Preoperative diagnosis was multinodular goiter (1040 cs.) and Basedow (63 cs.) and surgical procedures performed were total thyroidectomy in 865 cs and subtotal thyroidectomy in 238 cs. In 92 cs were diving goiter and in 157 patients were diagnosed with large nodular goiter (>100 gr). The surgery made by 123 patients with thyroid carcinoma and 980 patients with benign pathology. Mean postoperative hospital stay was 2.5 days. In the group of 1032 patients without preoperative suspicion of neoplasia (cytology not performed preoperatively or negative) hidden carcinomas were 11.7% (121 patients) what requiring 11 surgical reinterventions for radicalization of subtotal thyroidectomy. In the group of 71 patients with preoperative suspicion of neoplasia by fine-needle aspiration papillary carcinoma were 2.8%, the rest being benign thyroid pathology. In the postoperative complications, recurrent nerve lesions were encountered in 78 cs (3.76% of 2206 nerves at risk). Bilateral paralysis immediate was encountered in 5 cs (0.4%): 2 cs after total thyroidectomy and 3 cs after subtotal thyroidectomy with permanent bilateral paralysis in all cases. The immediate unilateral paralysis was encountered in 73 patients, (6.6%/3.3% nerves): 40 cs (4.6%) after total thyroidectomy and 33 cs (13.8%) after subtotal thyroidectomy (p <0.0001). But permanent unilateral paralysis was recorded in 16 patients (1.4%/0.7% nerves): 9 cs (1.0%/0.5% nerves) after total thyroidectomy and 7 (2.9%/1.4% nerves) after subtotal thyroidectomy with insignificant p 0.030. Postoperative hypocalcemia secondary lesions of parathyroid glands was recorded in 222 patients. The permanent hypocalcemia was encountered in 52 cs (6%) after total thyroidectomy and 14 cs (5.8%) after subtotal thyroidectomy with insignificant p 0.8311. Conclusions: The incidence of recurrent nerve lesions, not higher even than in the total thyroidectomy versus subtotal thyroidectomy. The incidence of residual permanent hypoparathyroidism superimposable between the two techniques. The high incidence of carcinomas

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