Evolution de la chirurgie thyroïdienne vers la thyroïdectomie totale: A propos de 735 cas

Abstract

To study the place of the total thyroïdectomy compared to the sub-total thyroidectomy and the lobectomy in benign nodular thyroid pathology, about complications and prevention of the recurrence.The evolution of the number and the type of thyroïdectomy among the total thyroidectomy, subtotal thyroidectomy and the lobectomy was analyzed in a retrospective study including 735 patients in the service of Head and Neck Surgery in the University Hospital in Amiens, France over a 12 years period, for a multinodular goiter, a toxic and a nontoxic solitary nodule. The post-operative transient and permanent recurrent nerve paralysis and hypocalcemia of the total thyroidectomies were studied and compared with the other surgical procedures of the study and in a review of the literature in order to study benefit and risks.Multinodular goiters were the most thyroid pathologies (80%). The total thyroidectomy became gradually the most frequent surgical procedure, from 17% to nearly 70% of the surgical procedures over 12 years, with depend on the currently abandoned subtotal thyroidectomy and the lobectomy. No significant difference appeared concerning the recurrent and parathyroid complications between the 3 procedures.The post-operative morbidity is not statistically different between the total thyroidectomy and the other procedures. The total thyroidectomy prevents moreover nodular recurrences whose surgical treatment is difficult without benefit of the L-thyroxine treatment prevention. It implies a substitute opotherapy that the other surgical techniques cannot nevertheless always avoid. Nowadays, the total thyroidectomy is the gold treatment for surgical treatment of multinodular benign goiters. Many factors must be considered concerning the solitary nodules: the size, the evolutivity, the fine needle aspiration the aspect of the contralateral lobe. In all the cases, the decision will have to be consensual between the patient, the endocrinologist and the surgeon.