Journal of Clinical and Experimental Investigations

Abstract

Objective: Recurrent goiter is a common problem following subtotal thyroid gland resection for multinodular goiter disease. The aim of the present study is to evaluate risk factors for recurrence, ultrastructural particularities of the thyroid and morbidity rate in relation to the side of initial and redo surgery for recurrent disease.
Methods: From January 2003 to December 2010 a total of 4,395 patients underwent consecutive thyroid gland surgery for nodular goiter at Department of Endocrine Surgery USBALE “Akad. Iv. Penchev” Hospital. Five hundred fifty one (12.5%) patients underwent redo-surgery for recurrent disease after subtotal resection. All of them with complete follow-up were included in the present study.
Results: Recurrent disease was found in 279 (50.7%) patients in the ipsilateral lobe and 272 (49.3%) patients in the contralateral lobe. The incidence of permanent recurrent laryngeal nerve palsy was significantly higher in patients with ipsilateral redo surgery compared to patients undergoing initial operation (3.9% vs. 1.2%; p<0.05) whereas no difference was found in patients with contralateral redo surgery compared to patients undergoing initial operation. Independent risk factors for contralateral recurrent disease were age at primary operation <30 years and familial history.
Conclusion: Our study showed that reoperation on the ipsilateral lobe is associated with a significantly higher morbidity rate compared to initial surgery. Reoperation on the contralateral lobe carries no additional morbidity. Further studies are necessary in order to evaluate whether lobectomy is sufficient for patients with familial history and unilateral goiter.