Multinodular goiter: surgical management and histopathological findings

The purpose of this study was to assess histopathological findings after a bilateral near-total thyroidectomy (residual thyroid tissue about 4 to 5 g) for multinodular goiter (MNG). The 270 patients included 238 women and 32 men with a mean age of 52 years (range: 19-82 years) who had MNG involving the entire gland and had undergone a primary bilateral surgical procedure between 1993-1998. There was no intra- or postoperative mortality. Indications for the MNG surgery were suspected malignancy (7.7%), thyrotoxicosis (27.7)%, pressure on cervical structures with tracheal deviation (38%), significant cosmetic deformity in young female patients (6.6%) and intrathoracic extension of the MNG (19.6%). Grave's disease was not included in our study. The surgical specimen weight ranged from 60 to 560 g (average 120 g). Final pathological findings were benign in 237 patients (87.8%) and malignant in 33 patients (12.2%). Nineteen patients were diagnosed with macroscopic (ten patients) or microscopic (nine patients) types of papillary carcinoma: there were two patients with the follicular variant of papillary carcinoma, three with lymphoma and Hashimoto's thyroiditis, three with medullar carcinoma, three with anaplastic carcinoma, two with follicular carcinoma and one with Hurthle cell carcinoma. A true total completion thyroidectomy was performed only for the medullary carcinoma patients and for four of the "high-risk" papillary carcinoma patients. Permanent (>12 months) unilateral recurrent paralysis occurred in four patients (1.4%), permanent (>12 months) hypoparathyroidism in ten patients (3.7%) and hypertrophic or keloid scar in 14 patients (5.1%). Our results suggest that near total thyroidectomy with minimal residual tissue is a versatile surgical procedure for various histopathological features in MNG patients. Low rates of postoperative complications were observed.