Surgical Treatment Of Thyroid Diseases Research Articles

Selective Arterial Embolization for the Management of Large Multinodular Cervicomediastinal Goiter

In the surgical treatment of thyroid disease, surgery of cervicomediastinal goiters has always been a challenge, due to the high risk of intraoperative and postoperative complications, especially excessive bleeding. Case report Fifty-one-year-old female patient with multiple underlying diseases, presenting a large cervical mass resulting to be a large multinodular cervicomediastinal goiter. Underwent selective arterial embolization of vascular branches supplying irrigation to the mass and later a total thyroidectomy with minimum blood loss during the intraoperative time. Conclusion Even if preoperative selective artery embolization is far from being a routine technique in cervicomediastinal goiter surgery, in selected patients who have many underlying medical problems, very voluminous goiter, high bleeding risk or high intraoperative risk, it can be considered a useful and safe procedure.

Identification and monitoring of laryngeal nerves: technologies and problems. Review

The review paper is devoted to an important problem of surgical treatment of thyroid diseases: avoiding injuries to the nerves of the larynx and the consequences associated with them. One of the ways to solve it is the identification and monitoring of nerves during surgery. An analysis of existing methods and technologies used for identification and monitoring of laryngeal nerves has been carried out. The issues of effectiveness and expediency of their application were considered. The definition of the terms «nerve identification» and «neuromonitoring of laryngeal nerves» has been outlined. The term «nerve identification» defines the procedure for identifying a nerve among the tissues of a surgical wound. Neuromonitoring is the constant monitoring of the nerve during the operation. In the prevention of laryngeal nerve injuries, it is important to combine these two actions and follow their sequence, the nerve identification should be the first, following by its monitoring during the surgery. The authors singled out two stages in the processes of identification and neuromonitoring of laryngeal nerves, electrical stimulation and recording the results of electrical stimulation. A detailed description of each of the stages is given, as well as methods and means of their implementation, technologies, positive and negative aspects. The author’s method of identification and neuromonitoring of laryngeal nerves using a laryngeal mask is described, which is based on the neurochronaxic theory of sound formation. The authors conclude the advisability of the identification and neuromonitoring of laryngeal nerves during operations on the thyroid gland, as they allow reducing the number of paresis of the larynx. Modern IONM technologies do not provide absolute accuracy. Some of them are technically complex, and the obtained results depend on many factors that significantly affect the reliability. The need to create a reliable, physiologically based, easy‑to‑use technology for identification and neuromonitoring of laryngeal nerves is emphasized.

Thyroid diseases in children and adolescents requiring surgical treatment-indications, techniques, results, and complications based on 10 years of the single center's own experience.

Although thyroid abnormalities are observed less frequently in children than in adults, the increased incidence of thyroid cancer makes it mandatory for all pediatric surgeons to be knowledgeable about the disorders of this gland. Thyroid abnormalities can be associated with hyperthyroidism or hypothyroidism and euthyroidism and/or symmetric or asymmetric enlargement of the gland. The present study was undertaken to retrospectively analyze the indications, surgical techniques used, results obtained, and complications found in the surgical treatment of thyroid diseases in children and adolescents in a surgical center for the macro-region of western Poland. The data of 148 patients undergoing total or partial thyroidectomy between 2013 and 2022 were analyzed from the medical records of the Department of Pediatric Surgery, Traumatology, and Urology of the Medical University of Poznan, Poland. A total of 95 children underwent subtotal thyroidectomy and 64 underwent total thyroidectomy, of which the procedure was widened to include prophylactic removal of neck lymph nodes in 45 patients. There were 113 girls (76%) in the analyzed group, and the average age of the patients at the time of surgical treatment was 15 years. The average time from the diagnosis of thyroid disease to surgery was 4 months, ranging from 2 weeks to 3 years. Of the 64 patients undergoing total thyroid resection, 35 (54.69%) were diagnosed with thyroid cancer. Collaboration within a multidisciplinary team ensures optimal surgical outcomes in children and adolescents with thyroid disease. With extreme caution, thyroid removal is a safe procedure with few complications, but the experience of the surgeon performing thyroid surgery in children remains crucial. Despite the absence of such a diagnosis in the first fine-needle aspiration biopsy, the high percentage of thyroid carcinomas in the analyzed group may be because the initial biopsy was performed in a less experienced center, also in terms of histopathological laboratory. Hence, we point out the necessity of performing a repeat fine-needle aspiration biopsy (according to the Bethesda classification) in a more experienced center before the final decision of thyroidectomy.

Topical issues of toxic goiter diagnosis and treatment

Among the causes of thyrotoxicosis, the diffuse toxic goiter is found in 75-80% of cases, the toxic multinodular goiter is observed in 20-25% of cases. The article presents the data on various aspects of surgical treatment of thyroid diseases found in international databases.

Innovative technologies in the diagnosis and safe surgical treatment of thyroid diseases

This study clarified the results of using innovative technologies in the diagnosis and surgical treatment of patients with thyroid diseases by evaluating the role of modern diagnostic methods and effectiveness of minimally invasive thyroid surgery. The results of a comprehensive examination and treatment of 332 patients with thyroid diseases, who were examined using modern diagnostic methods and underwent conventional and various minimally invasive approaches, were analyzed. The sensitivity, specificity, accuracy, and positive and negative predictive values of multiparametric neck ultrasonography, 99mTc-MIBI thyroid scintigraphy, fine-needle cytology, and molecular testing of thyroid nodules were compared. The minimally invasive procedure was performed in 70.4% of the patients. Postoperative complications were found in 4.9% of the patients who underwent surgery, functional dysphonia in 0.9%, and transitory hypoparathyroidism in 2.4%. The use of the main criteria that determine the choice of a rational minimally invasive surgery, such as the nodule size and thyroid volume, hyperfunctioning thyroid, clinical thyroiditis, substernal extension, extrathyroid extension, and necessity of implementation of central and lateral neck dissection due to lymph node metastases, avoids the conversion of access to the traditional approach, prevents damage to the recurrent laryngeal nerve with the development of transitory or permanent recurrent laryngeal nerve palsy, and minimizes injury to the parathyroid glands with the development of isolated cases of transient hypoparathyroidism. Therefore, results of the multiparametric analysis of the examination and surgical treatment outcomes of patients with thyroid diseases show the feasibility of using innovative technologies in their diagnosis and surgical treatment. Modern examination methods allow us to determine with great accuracy the morphological form of thyroid disease and choose a rational volume and surgical intervention. In this study, minimally invasive procedures are optimal and safe in the surgical treatment of this category of patients.

ВЛИЯНИЕ ИНТРАОПЕРАЦИОННОГО НЕЙРОФИЗИОЛОГИЧЕСКОГО МОНИТОРИНГА НА ВАРИАНТ АНЕСТЕЗИОЛОГО-РЕАНИМАЦИОННОГО ОБЕСПЕЧЕНИЯ В ХИРУРГИИ ЩИТОВИДНОЙ ЖЕЛЕЗЫ

Objective: To assess the effect of intraoperative neurophysiological monitoring (IONM) on the incidence of life-threatening complications of the surgical treatment of thyroid diseases in the operating room and intensive care unit. Methods: A retrospective analysis of the medical records of 212 patients aged 31 to 72 was carried out. Depending on the treatment modality, they were divided into two groups. In group I (study group, n=96), IONM was used during surgery, and in group II (control group, n=116) – the surgery was performed without IONM. The effectiveness of IONM was assessed based on the number of complications and tracheal reintubation in the postoperative period. Results: IONM contributed to a statistically significant decrease in the number of postoperative complications. Thus, injury to the recurrent laryngeal nerve (RLN) was noted in 1 (1.0%) patient in the study group versus 17 (14.6%) in the control group (p<0.05); hoarseness was present in 3 (3.1%) and 35 (30.1%) cases in the study and control groups, respectively (p<0.05). In addition, although statistically insignificant, there was a reduced rate of tracheal reintubation: in two (2.1%) and (6.0%) patients in the study and the control groups, respectively (p>0.05). Of these, 5 (4.3%) patients needed surgeries due to bilateral injury to the RLN. The decrease in the incidence of complications, in turn, contributed to a reduction in both the average lengths of stays in the intensive care unit (6.2±0.5 days and 7.4±0.3 days in the study and the control groups, respectively, p>0.05) and the overall treatment time (59.1±1.7 and 121.3±4.8 patient days in the study and the control groups, respectively, p<0.05). Conclusion: IONM in thyroid surgery can reduce the number of complications, such as damage to the recurrent laryngeal nerve, although it does not exclude them entirely. The data obtained allow us to recommend using IONM in everyday practice. Keywords: Recurrent laryngeal nerve paralysis, the thyroid gland, neurophysiological monitoring, thyroidectomy, postoperative complications, tracheal reintubation.

Short-Term Hypocalcemia Prophylaxis With Calcitriol Before Thyroidectomy.

Total thyroidectomy is the most common surgical treatment of thyroid diseases, and postoperative hypocalcemia is its most common complication. Hypocalcemia prolongs the patient's hospital stay and impairs his or her quality of life. Although a low vitamin D level is a recognized risk factor, the utility of preoperative vitamin D administration to prevent postoperative hypocalcemia is unclear. In this trial, therefore, we studied the effect of giving vitamin D before total thyroidectomy. In a multicenter, randomized, minimally interventional trial (registration number: DRKS 00005615), patients about to undergo total thyroidectomy were randomized either to an intervention group that received 0.5 μg of calcitriol per os twice daily for three days up to the day immediately before surgery, or to a control group that did not (no placebo was given). The primary endpoint was the absence of hypocalcemia (serum calcium <2.1 mmol/L) in the postoperative course. Of the 287 patients recruited in six hospitals over the period 23 July 2014 to 20 March 2017, 246 were included in the final analysis. The intervention and control groups did not differ significantly with respect to the rate of postoperative hypocalcemia (29.2% and 33.6%, respectively; p = 0.546, power 8.8%). The duration of postoperative hypocalcemia was, however, shorter in the intervention group (3.5 vs. 7 days; p = 0.016, power 68%). The rates of hypocalcemia in the individual trial locations varied widely, ranging from 13.9% to 71.4%. Short-term administration of calcitriol did not affect the rate of occurrence of hypocalcemia after thyroidectomy, but did shorten its duration. The rate of postoperative hypocalcemia varied widely across hospitals, probably because of differences in surgical technique.

Comparison of thyroid surgery experiences of "East" and "West" regions in Turkiye.

OBJECTIVEThis study aimed to evaluate the differences between the types of thyroidectomy surgeries and surgical treatment approaches according to thyroid pathology results, in Turkiye’s two non-endemic regions.METHODSTwo different centers of the country, which differ in many respects and are non-endemic for thyroidal diseases were included in the study. Data on patients from both sexes, who underwent thyroidectomy in the western (1st center) and the eastern (2nd center) regions between 2011 and 2017 have been reviewed.RESULTSTwo hundred and forty patients from Istanbul (1st center) and 992 patients from Van (2nd center); a total of 1232 patients were included in the study. According to the pre-operative ultrasonography and laboratory results, toxic nodular goiter and multinodular goiter were the most common diseases in the first and second centers, respectively. There was a significant statistical difference between the radiological diagnostic findings between the two centers (p<0.001). The rate of bilateral total thyroidectomy in the first center was 82.5% (198 patients), whereas this rate was 58.5% (555 patients) in the second center. The type of surgery may change from center to center, (p<0.001). The most common early post-thyroidectomy complication was hypocalcemia in both centers.CONCLUSIONThe results from only two centers from the western and eastern Turkiye show that there is a difference between the thyroidectomy preferences. Future similar national studies will contribute to the provision of a consensus in surgical treatment of thyroid diseases.

Energy-based devices for hemostasis in thyroid surgery.

The evolution of operative techniques in thyroid surgery that has taken place over the past several decades would not have been possible if not for a sui generis revolution in surgery at the turn of the 19th and 20th centuries. The three most important events of the end of the 19th century, i.e., the introduction of anesthesia, the use of artery forceps and ligation of blood vessels, as well as prophylactic management of perioperative infections decidedly affected the improvement of therapeutic results of thyroid surgery. Surgical treatment of thyroid diseases is associated with the possibility of complications developing, of which bleeding is among the most serious ones, starting from the need for an immediate reoperation and ending at a considerable damage to functionally important structures: the laryngeal nerves and parathyroid glands. The consensus reached between the development of science and progress in modern technologies has provided the basis for introducing and popularizing minimally invasive procedures, including operations using the approach through natural body openings. Such an unprecedented development of surgical techniques would not be possible without devices for closing blood vessels. Given the mechanism of hemostasis, current vascular sealing devices can generally be divided into three groups: ultrasonic, bipolar-radiofrequency and hybrid systems combining both energy modalities. While analyzing the innovative, advanced technology of all the energy-based devices, it should be stated that only if they are used in a safe manner, quality of life of patients with various thyroid conditions is improved. The employment of such devices fully confirms their usefulness; nevertheless, all the advantages should never release the surgeon from the obligation to appropriately and safely identify the surrounding structures and let him uncritically use the new device.

Transoral Endoscopic Thyroidectomy by Vestibular Approach-Initial Experience and Comparative Analysis in the First Reported Mexican Cohort.

Introduction: Transoral endoscopic thyroidectomy by vestibular approach (TOETVA) is a relatively new technique for the surgical treatment of thyroid diseases. We present the initial experience of a reference hospital of Mexico with TOETVA. Materials and Methods: This is a comparative retrospective study of cases (TOETVA) and controls (open thyroidectomy) treated by the endocrine surgeons between July 2017 and April 2019. Cases were patients of any gender, older than 18 years of age, with malignant thyroid nodules <2 cm or undetermined <5 cm without extrathyroidal extension and no lymph node or distant metastasis. Demographic, operative, and postoperative data were obtained and analyzed. Results: Twenty patients were surgically treated by TOETVA during the study period. Controls were paired based on type of surgery and dominant thyroid nodule. Ninety percent of the patients had a definitive diagnosis of malignancy. No statistically significant differences were found in age, BMI, length of stay, thyroid lobes size, and complication rates. Operative time was longer in TOETVA (216.7 ± 62.5 vs. 153.9 ± 49.25 minutes; t test P < .0001) and intraoperative blood loss was lesser for the TOETVA group (38.25 ± 38.9 vs. 101.8 ± 126.6 mL; t test P < .04). Conclusions: TOETVA is a feasible and relatively safe surgical technique for patients with benign and malignant thyroid diseases. Complication rates seem to be comparable with conventional open technique with lesser intraoperative bleeding; nevertheless, it requires longer operative times.

The first experience of laser spectroscopy in the surgical treatment of thyroid diseases

For assessing the efficacy of intraoperative laser autofluorescent spectroscopy (IOLAS), 46 patients with thyroid diseases of different etiology are examined. The patients ’ aged varied from 30 to 65 years. The following morphological types of diseases were observed: benign nodular formations in 42 patients, thyroid cancer in 4, papillary TINO MO in 2, and follicular cancer TINO MO in 2 cases. Out of benign formations, 36 were multinodular colloid goiter and 6 follicle-cell adenomas. As a result of using IOLAS, thyroid cancer was diagnosed during surgery in 8 (17.4%) out of 36 patients with multinodular colloid goiter; this diagnosis necessitated more extensive intervention than was planned: subtotal resection had to be extended to thyroidectomy. In all the cases IOLAS data were confirmed by urgent and later planned histological analyses. Due to this method, no reoperations were needed, which previously had to be performed because of the data of planned histological analysis, and therefore, the probable complications of reoperations were prevented. Our data indicate that IOLAS more accurately identifies the type and morphology of thyroid involvement and helps choose adequate volume of intervention. The first experience with laser fluorescent study as optic biopsy holds good promise as regards improvement of intraoperative rapid diagnosis of thyroid diseases.

Oncological concernings in patients with graves’ disease

Introduction: Recently, the change of attitude in the surgical treatment of thyroid diseases offers more radical surgical solutions. This has also affected the surgical technique of Graves’ disease, in which total / near-total thyreoidectomy is recommended nowadays, with a lower recidive rate. In the case of Graves’ disease, preoperatively is more difficult to diagnose malignant tumors, so providing adequate intervention with adequate surgery at a first level is crucial to avoid complications. Patient and Method At the University of Debrecen Department of Surgery a total of 2857 thyroid surgeries were performed between 2012-2017, of which 190 (6.65%) were performed due to Graves' disease (156 female age 40 ± 14 years, 34 male - mean age 42 ± 14 years Results In 69 cases (36.3%) near-total thyroidectomy, in 109 cases (57.3%) total thyreoidectomy and in 12cases (6.3%) subtotal resection were performed. Recurrent hyperthyroidism resulted in 4 patients (2.1%) who had undergone a complete surgery over 5 years. Histological examination revealed 9 malignancies (4.73%), in 8 cases papillary, in one the case of follicular carcinoma was discovered. Hypocalcemia, requiring substitution after surgery occured in 8 (4,2%), wound seroma in 3 (1,5%) n.laryngeus recurrens paresis in 2 (1.05%), bleeding in 1 (0.5%) case.

TRANSAXILLARY ENDOVIDEOSURGICAL ACCESS IN THYROID SURGERY

OBJECTIVE. The aim of the study is to analyze the results of practical application of endovideosurgical transaxillary access in thyroid surgery. MATERIAL AND METHODS. We performed the retrospective comparative analysis of the results of surgical treatment of thyroid diseases using traditional, Miccoli’s endovideo-assisted access, endovideosurgical transaxillary access. RESULTS. With the use of endovideosurgical transaxillary access, the best cosmetic result is achieved – the absence of a scar on the neck. The number of specific complications in the samples is not significantly different, nonspecific complications are not accompanied with functional disorders. CONCLUSION. The expediency of improving the endovideosurgical thyroid surgery from remote accesses showed demand ability and safety of the technique. The important condition for their application is the possibility of performing an operative intervention in a proper manner.

Future directions of transoral endoscopic thyroidectomy vestibular approach

The surgical treatment of thyroid disease goes far beyond merely eliminating the cancer and or thyroid related symptoms. Surgeons, endocrinologists, oncologists, and patients now understand surgical treatments and cosmetics results must be integrated. In well-run comprehensive endocrine Centres using state-of-the-art technology, the majority of patients will be treated by conserving therapy when a screen detected little tumor has been visualized and with a minimally invasive surgery.

Pay attention to the standardized application of new techniques in surgical treatment of thyroid disease

The continuous development and application of new technology in thyroid surgery has promoted the rapid improvement of thyroid surgery. New technology in the field of thyroid surgery has developed rapidly. The application of neural monitoring technology has enabled the thyroid surgery to enter an accurate era. Imtraoperative neuromonitoring and continuous intraoperative neuromonitoring have made the recurrent laryngeal nerve protection more secure. Nano-carbon parathyroid gland negative imaging technology could identify parathyroid gland more precise. However, when the nano-carbon was used, the injection time, position and dosage should be grasped so as to achieve the best effect of negative imaging. Endoscopic and robotic thyroid surgery could meet the demand of cosmetic. "Treatment first, beauty second" is still the principle to be strictly followed. Do not blindly expand indications and pursue endoscopic surgery. Energy surgical instruments' update made the operation more efficient, while the instruments have some disadvantages. Thyroid surgeon must correctly understand the working principle of new energy devices and use them rationally. Through grasping the working principle and application skills of new technology in clinical work, definiting its advantages and disadvantages, adhereing to the "reasonable choice, standard application" principle, learning the pioneers' experience, the application of new thyroid diagnosis and treatment technology could be more reasonable and safe.

Outcomes of surgical treatment of thyroid disease in children

Background. In recent years there has been a tendency of increase in the proportion of nodular goiter and Graves’ disease in thyroid pathology in children, which necessitates a choice of rational tactics for treatment of these diseases. At present there is no optimal method of treatment for thyroid gland pathology, but one of the methods is surgery. Thyroid surgery due to the determination of the indications and choice of the optimal volume of the surgical intervention continues to be under debate as postoperative complications of surgical treatment of thyroid diseases in children are possible. Aim: to study the outcomes of surgical treatment for thyroid pathology in children, depending on the volume of operation. Materials and methods. This article presents the results of a survey of 77 children operated on in the period of 2002–2016 for Graves’ disease, single-node goiter, and multinodular goiter. The examination included the determination of the levels of ionized calcium and TSH, FT4, FT3 in the blood serum, the evaluation of the functional state of the pituitary-thyroid system, thyroid ultrasound examination, and examination by an otolaryngologist. Results. The incidence of adverse outcomes of surgical treatment in children with nodular goiter was 27%. Adverse outcomes were observed equally often after organ-preserving operations and after thyroidectomy, but they were of different structure. The frequency of postoperative complications after thyroidectomy performed on the nodular goiter was 27%. Complications presented as postsurgical hypoparathyroidism and vocal cord paresis. In children with nodular goiter, after thyroidectomy hypoparathyroidism occurred more frequently than paresis of the vocal folds. Symptomatic hypocalcemia was observed more frequently than the asymptomatic variant, and in most cases hypoparathyrodism was transient. Among children with a single-node goiter who underwent organ-preserving surgery on the thyroid gland postoperative complications such as hypoparathyroidism and paresis of the vocal folds were not identified. Adverse outcomes (disease recurrence, postoperative hypothyroidism) were observed equally often after hemithyrodectomy and node enucleation. But the risk of recurrence of nodular goiter was significantly more common in children after node enucleation than after hemithyroidectomy and postsurgical hypothyroidism was more common in children with nodular goiter after hemithyrodectomy than after node enucleation. The frequency of adverse outcomes of surgical treatment of Graves’ disease in children was 14%. Complications were presented by post-surgical hypoparathyroidism and vocal cord paresis. All complications occurred only after thyroidectomy. When compared adverse outcomes of thyroidectomy were equally common in both nodular goiter and Graves ‘disease, but persistent dysfunction in the form of permanent hypoparathyroidism and permanent vocal cord paresis were more common in Graves’ disease than in nodular goiter. Conclusion. The results obtained demonstrate the heterogeneity of surgical treatment outcomes structure which depends on the surgical intervention volume.

Surgical treatment of thyroid disease with the use of technology LigaSure

Surgical treatment of thyroid disease with the use of technology LigaSure

Surgical treatment of thyroid disease: descriptive analysis and histopathology of a series of 92 cases

Surgical treatment of thyroid disease: descriptive analysis and histopathology of a series of 92 cases

Humanitarian Goiter Surgery: Ethics and Best Practices in Low‐Resource Settings

Program Description: Iodine deficiency has largely been eradicated in the developed world, but many lower resource countries demonstrate persistent iodine deficiency, goitrogen abundance, or both. In addition, some areas with high rates of thyroid malignancy have not had the resource capacity to fully address the need. Thus, surgical treatment of thyroid disease has comprised a significant proportion of head and neck related humanitarian surgery. This miniseminar, which is endorsed by the Humanitarian Efforts and Endocrine Surgery Committees, will be targeted to an audience of thyroid surgeons and those experienced in humanitarian surgery in low to medium resource settings. The presentations will be didactic, but with opportunity for discussion as well as audience interaction for the potentially controversial aspects. After introductory remarks, the audience will be queried for experience in humanitarian thyroid surgery and current management practices. The ethics of defining standard care with respect to resources and regional standards will be discussed. Evidence-based standards of thyroid surgery in the developed world will be contrasted to those in the variety of settings in which goiter surgery occurs in the developing world. The public health implications of goiter within the larger context of iodine deficiency will be discussed. Management of thyroid surgery in variable-resource settings will be presented in 3 components: 1) Pre-operative workup and patient selection will be discussed with respect to clinical presentation, diagnostic workup (labs and imaging), medical correction of hypothyroidism and iodine deficiency, and preoperative preparation. 2) Intraoperative management will be discussed including controversies in the use of technologies such as recurrent nerve monitoring and various cutting tools. 3) Postoperative management, including use of drains, hospital stay, calcium monitoring, thyroid supplementation, and long-term follow-up will be discussed. Complications of thyroid surgery in variable resource settings, including bleeding/ hematoma, recurrent nerve injury and hypoparathyroidism will be addressed as well as the need and risks for reoperation. In conclusion, a model for evidence-based standardization of thyroid surgery based on resource availability will be presented. The role of the thyroid surgeon as a conduit for population screening and treatment will be introduced. Research opportunities will be suggested, in particular with respect to greater understanding of a region’s iodine and goitrogen levels, medical management as an alternative to surgery, and measuring the impact of higher level management. The audience will again be queried to demonstrate a greater understanding of the topic and to determine if management opinions have been altered. Educational Objectives: 1) Understand the challenges faced in performing thyroid surgery during international humanitarian mission work. 2) Discuss ethics in surgical decision-making in low-resource settings: what is the minimum standard of care? 3) Be able to tailor treatment plans to the patient and the environment within best practices.

Surgical treatment of thyroid diseases in elderly patients

Background We evaluated the safety of thyroid surgery in elderly patients, in whom surgical procedures usually are considered more hazardous than in younger patients. Methods The medical records of all the patients who were aged 70 years or older who had undergone thyroid surgery between January 1998 and June 2008 were reviewed. Results A total of 320 patients were included. The preoperative diagnosis was multinodular goiter in 171 cases, toxic goiter in 59 cases, suspicious or indeterminate thyroid nodule in 60 cases, and thyroid carcinoma in 30 patients. Total thyroidectomy was performed in 283 patients, thyroid lobectomy in 15 patients, and a completion thyroidectomy was performed in 22 patients. The final histology showed thyroid cancer in 86 patients and benign disease in 234. Conclusions Thyroid surgery in patients aged 70 years or older is safe and the relatively high rate of thyroid carcinoma and toxic goiter may justify an aggressive approach.