State of the art: surgery for endemic goiter

Abstract

1. Dralle et al. have based their observations on a publication from Germany (reference 50, Table 1). Majority of the operations performed by the surgeons in that study was either subtotal thyroidectomy (STT, n=4580) or unilateral lobectomy and contralateral subtotal (n=527). Nine thousand eight hundred seven operations performed were less than total thyroidectomy (TT), and only 88 were TT. The incidence of RLN palsy was 2.3% which could be due to the fact that these surgeons were performing surgeries less than TT, and hence, they had less experience in TT. Dralle has based his calculation of 23 cases of RLN palsy in 1,000 thyroidectomies on these data. However other publication has shown that the permanent RLN palsy ranged from 0% to 1.7% [1] (based on 27 studies). Majority (14 studies) had RLN palsy rates <0.5%. If these data are used, 1,000 TT would have resulted in only five cases of RLN palsy. 2. The authors have assumed that only 5% of the recurrences get operated. The incidence of RLN palsy with reoperation was 3.6%. We should realize two points.