Toxic multinodular goiter surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2],Sunny Kumar MD [3]
Overview
Surgery is the mainstay of treatment for toxic multinodular goiter. Almost all multinodular goiters can be surgically removed through a collar incision. Usually, subtotal thyroidectomy is performed but unilateral thyroid lobectomy can also be performed in selected cases.
Surgery
Surgery is the mainstay of treatment for toxic multinodular goiter.[1][2][3][4][5][6]
Indications
Indications of surgery for multinodular goiter (MNG) includes:
- Rapid enlargement of goiter
- Rapidly enlarging thyroid nodules
- FNAC is positive or suspicious of malignancy
- Compression of trachea, esophagus, and other neck structures
- Substernal thyroid extension
- Co-existence of hyperparathyroidism
- Risk of malignancy
- Suspicious cervical lymphadenopathy
- Radiation exposure
Surgical procedures
Almost all multinodular goiters can be surgically removed through a collar incision. An additional thoracotomy is very rarely necessary.
- If surgery is chosen as treatment for TMNG or TA, patients with overt hyperthyroidism should be rendered euthyroid prior to the procedure with MMI pretreatment, with or without b-adrenergic blockade. Preoperative iodine should not be used in this setting.[1]
Total thyroidectomy
Benefits of total thyroidectomy include:[7]
- Adequate removal of the diseased gland
- Prevention of recurrence
- Avoidance of completion surgery in case of malignancy
Subtotal thyroidectomy
Bilateral subtotal thyroidectomy includes total lobectomy on the dominant lobe and subtotal lobectomy on the contralateral lobe. Bilateral subtotal thyroidectomy is effective in the treatment of multinodular goiter (with hot or cold nodules).[7]
Benefits of Subtotal thyroidectomy:
- Comparable to total thyroidectomy
- Low incidence of hypoparathyroidism
Unilateral Lobectomy
A unilateral thyroid lobectomy may be performed if only one thyroid lobe is enlarged.
Side effects of surgery
The side effects associated with thyroidectomy include:[8][9][10]
- Post-operative hypothyroidism
- Recurrent laryngeal palsy
- Hypocalcaemia secondary to hypoparathyroidism
Radioactive iodine therapy
The indications of radioactive iodine therapy includes:
- Advanced patient age
- Significant comorbidity
- Prior surgery or scarring in the anterior neck
- Small goiter size
References
- ↑ 1.0 1.1 Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, Rivkees SA, Samuels M, Sosa JA, Stan MN, Walter MA (2016). "2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis". Thyroid. 26 (10): 1343–1421. doi:10.1089/thy.2016.0229. PMID 27521067.
- ↑ Hurley DL, Gharib H (1996). "Evaluation and management of multinodular goiter". Otolaryngol. Clin. North Am. 29 (4): 527–40. PMID 8844728.
- ↑ "Treatment and Prevention of Recurrence of Multinodular Goiter: An Evidence-based Review of the Literature | SpringerLink".
- ↑ "www.bprcem.com".
- ↑ "Thyroid nodules: pathogenesis, diagnosis and treatment - Best Practice & Research Clinical Endocrinology & Metabolism".
- ↑ Moalem J, Suh I, Duh QY (2008). "Treatment and prevention of recurrence of multinodular goiter: an evidence-based review of the literature". World J Surg. 32 (7): 1301–12. doi:10.1007/s00268-008-9477-0. PMID 18305998.
- ↑ 7.0 7.1 "Comparison of the Complications of Subtotal, Near Total and Total Thyroidectomy in the Surgical Management of Multinodular Goitre".
- ↑ Pelizzo MR, Bernante P, Toniato A, Fassina A (1997). "Frequency of thyroid carcinoma in a recent series of 539 consecutive thyroidectomies for multinodular goiter". Tumori. 83 (3): 653–5. PMID 9267482.
- ↑ "Complications after Total ThyroidectomyOtolaryngology-Head and Neck Surgery - Larry J. Shemen, Elliot W. Strong, 1989".
- ↑ "Morphological and functional polymorphism within clonal thyroid nodules | The Journal of Clinical Endocrinology & Metabolism | Oxford Academic".