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Invited Critique: Total Thyroidectomy for Bilateral Benign Multinodular Goiter
Clive S. Grant, MD
Rochester, Minn
Arch Surg. 1999;134:1393.
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Delbridge and his colleagues should be complimented on a large series of patients who underwent both subtotal and total thyroidectomy with incredibly low complication rates. Although nearly one third of their patients required 3 to 6 weeks of calcium supplementation, fewer than 0.5% developed permanent hypoparathyroidism. They attribute this extraordinary record in part to routine autotransplantation of 1 parathyroid gland at the time of total thyroidectomy. While we employ liberal use of parathyroid autotransplantation in similar circumstances, a single autotransplanted gland as the only protection for hypoparathyroidism seems optimistic.
The central premise of this study lies in the balance of leaving a small quantity of thyroid tissue to resolve symptoms and prevent recurrence, yet minimize the risk of complications—principally, permanent recurrent laryngeal nerve paralysis and hypoparathyroidism. There is little question that if large thyroid nodules or nodular goiter is left behind, the risk of persistent symptoms . . . [Full Text of this Article]
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Total Thyroidectomy for Bilateral Benign Multinodular Goiter: Effect of Changing Practice
Leigh Delbridge, Ana I. Guinea, and Tom S. Reeve
Arch Surg. 1999;134(12):1389-1393.
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