Safety and Effectiveness of Total versus Subtotal Thyroidectomy in Management of Simple Multinodular Goiter

Abstract Background: Disorders of the thyroid gland constitute the second most common endocrine disease following diabetes mellitus. The prevalence of nodular goiter and thyroid auton-omy is increased in regions with chronic Iodine Deficiency (ID). It has been documented that the thyroid gland adjusts to ID in the early stages by diffuse hyperplasia, while chronic exposure to ID results in nodular hyperplasia, increased colloid content and increased height of the follicular cells. Aim of Study: To compare between total and subtotal thyroidectomy in management of Multinodular Goiter as regard safety and effectiveness and post-operative complica-tions like: Hypocalcaemia, recurrent laryngeal nerve injury and hypoparathyroidism. Material and Methods: This prospective study was done at Ain Shams University Hospitals and Banha teaching hospital during the period between March and September 2019. This study included 40 cases of SMNG. Their age was between 30 to 45 years, consent was taken from each patient pre-operatively. Agreement of ethical committee was done. Results: Our study showed the advantages of total thy-roidectomy include adequate eradication of the disease, prevention of recurrent goiter and avoidance of the need for completion surgery in case of occult malignancy, but it is associated with higher morbidity (postoperative thyroidectomy complications: RLN palsy and hypoparathyroidism) and the need for lifelong replacement therapy (L-thyroxin supplemen-tation). Conclusion: In MNG, there are a high percentage of cases with disease involving the entire gland; many areas of appar-ently healthy tissue are found to be microscopically involved with variable grade of chronic lymphocytic thyroiditis or follicular hyperplasia or even lobular dysplasia with tendency to form nodules. These signs of disease of this organ tend to recurrence if not treated.