The advantage of total thyroidectomy to avoid reoperation for incidental thyroid cancer in multinodular goiter

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 I 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.