Post-Operative Long-Term Results of Patients with Benign Thyroid Nodules

Lee, Ho Kyun; Yoon, Jung Han; Jeagal, Young Jong

Abstract

PURPOSE
Patients with benign thyroid nodules, presenting symptoms such as dysphagia and choking sensation, increasing tendency of nodular size, or failure of medical treatment, may need surgical management. However, the guidelines for surgical management and optimal extent of resection for benign thyroid nodules were not definitely established until yet. The aim of this study is to evaluate the complications related with extent of surgical resection and to determine the optimal surgical procedure for benign thyroid nodules through long-term results.
METHODS
Fifty-five cases with benign thyroid nodules who received surgery at Department of Surgery, Chonnam National University Hospital Jan. 1993 to Dec. 1996 were retrospectively evaluated. Inclusion of criteria were follows: pathologically benign, with normal on preoperative thyroid function study, follow-up period with 5 years or more. Follow-up studies were consisted of physical examination, neck ultrasonography, thyroid function test, determination of serum PTH-i and serum calcium level, and laryngoscopic examination if necessary.
RESULTS
Male to female ratio was 1 to 6.8. Fourth and fifth decades occupied majority (58.2%) of patients. The most common symptom at initial diagnosis was palpable mass on the cervical area (90.9%), followed by palpitation (5.6%) and voice change (5.6%) as their complaints in decreasing order. Average follow-up period was 6.3 years, complications after surgery such as hypoparathyroidism were more frequent in total and subtotal thyroidectomy group than lobectomy group. However, nodular recurrence in remanant thyroid tissues was 13.8% in lobectomy and 9% in subtotal thyroidectomy, The significant factors associated with recurrence were absent, except for age.
CONCLUSION
Although remnant thyroid tissue have potential of nodular recurrence, total thyroidectomy have a more risk of permanent hypoparathyroidism. Therefore, we would like to recommend that surgical extent for benign thyroid nodules need to be determinated by experience and skill of surgeon and patient's compliance for long-term medication and regular follow-up study to detect nodular recurrence in remanant thyroid earlier.