Treatment and prevention of recurrence of multinodular goiter: an evidence-based review of the literature

Abstract
Background  Reportedly, 10−15% of patients with goiters ultimately require operative intervention, and recurrences of multinodular goiter
(MNG) account for up to 12% of all thyroid operations.

Methods  We performed an evidence-based review of articles published in the English language between January 1987 and October 2007
relevant to the subject.

Results  Medical treatment with T4 appears to be associated with a greater proportion of patients whose nodules decreased in size by
more than 50% (22% vs. 10%; range = 14–39% vs. 0–20%). Recurrence rates of benign nodular goiter after total thyroidectomy
were essentially nonexistent (range = 0–0.3%) compared with those after subtotal thyroidectomy (range = 2.5–42%) and more
limited resections (range = 8–34%). There was no difference between total and less-than-total thyroidectomy with respect to
temporary recurrent laryngeal nerve (RLN) injury (1–10% vs. 0.9–6%, respectively) or permanent RLN palsy (0–1.4%). There was,
however, a significantly higher rate of transient hypocalcemia after total thyroidectomy than less extensive operations (9–35%
vs. 0–18%, respectively). In relation to redo surgery, permanent hypoparathyroidism appeared to be far more common in the
redo group (0–22% vs. 0–4%) Moreover; the redo group had more frequent RLN injury, both temporary (0–22% vs. 0.5–18%) and
permanent (0–13% vs. 0–4%). About half the studies examined conclude that postoperative TSH suppression is effective in reducing
recurrences, while the other half state that it is not.

Conclusion  The definitive management and prevention of recurrence of benign nodular goiter is primarily surgical. Total thyroidectomy
essentially eliminates the risk of recurrence without an accompanying increased risk of permanent hypoparathyroidism or RLN
injury. Therefore, total thyroidectomy should be considered the procedure of choice for benign multinodular goiter whenever
possible, especially considering that reoperations for goiter are significantly more morbid than any initial operation.

Content Type Journal ArticleDOI 10.1007/s00268-008-9477-0Authors
Jacob Moalem, University of California Endocrine Surgery San Francisco CA 94143 USAInsoo Suh, University of California Endocrine Surgery San Francisco CA 94143 USAQuan-Yang Duh, University of California Endocrine Surgery San Francisco CA 94143 USA

Journal World Journal of SurgeryOnline ISSN 1432-2323Print ISSN 0364-2313 (Source: World Journal of Surgery)