Our Summary

This study is a comprehensive comparison of two treatments for a non-harmful, multi-nodular thyroid condition (BMNG). These two treatments are total thyroidectomy (TT), where the entire thyroid is removed, and less than total thyroidectomy (LTT), where only a portion of the thyroid is removed. Researchers analyzed five different studies where TT was compared to LTT.

They found that the rate of BMNG coming back was lower in the TT group compared to the LTT group. Other side effects like temporary or permanent damage to the recurrent laryngeal nerve (a nerve in the throat) and permanent hypoparathyroidism (a condition that can cause low calcium levels) were similar in both groups. However, temporary hypoparathyroidism was less common in the LTT group.

The research didn’t clearly show that one procedure was better than the other in terms of BMNG coming back or the need for more surgery. But the need for more surgery because of BMNG coming back was higher in the LTT group based on one study. They also found that temporary hypoparathyroidism was more common in the TT group, but there was no difference in damage to the recurrent laryngeal nerve or permanent hypoparathyroidism between the two groups.

The quality of the evidence they found was rated as low to moderate, possibly because it was unclear if the people in the studies knew which treatment they were getting and because of potential biases in how the results were reported.

FAQs

  1. What are the two treatments compared in the study for a non-harmful, multi-nodular thyroid condition?
  2. What were the differences in side effects between total thyroidectomy and less than total thyroidectomy?
  3. Did the study conclude one procedure was better than the other for treating BMNG?

Doctor’s Tip

A helpful tip a doctor might tell a patient about thyroidectomy is to closely follow post-operative care instructions, including taking prescribed medications, attending follow-up appointments, and monitoring for any signs of complications such as difficulty breathing, excessive bleeding, or changes in voice. It’s also important to communicate any concerns or symptoms to your healthcare provider promptly.

Suitable For

Patients with non-harmful, multi-nodular thyroid conditions (BMNG) are typically recommended thyroidectomy, specifically total thyroidectomy (TT) or less than total thyroidectomy (LTT) based on the severity of their condition. These patients may have symptoms such as difficulty swallowing, breathing, or speaking, as well as an enlarged thyroid gland that is causing discomfort or cosmetic concerns. Additionally, patients with thyroid cancer, Graves’ disease, toxic nodular goiter, or other thyroid conditions that are not responding to medication may also be recommended for thyroidectomy. It is important for patients to discuss their individual case with their healthcare provider to determine the most appropriate treatment option for their specific condition.

Timeline

Before thyroidectomy:

  1. Patient experiences symptoms of BMNG such as difficulty swallowing, breathing, or speaking, hoarseness, and neck swelling.
  2. Patient undergoes diagnostic tests such as thyroid ultrasound, fine needle aspiration biopsy, and blood tests to confirm the diagnosis.
  3. Patient consults with an endocrinologist or surgeon to discuss treatment options and risks.
  4. Patient may undergo preoperative preparation such as medication adjustments, blood tests, and imaging studies.
  5. Patient signs consent forms and undergoes anesthesia evaluation before the surgery.

After thyroidectomy:

  1. Patient undergoes the surgical procedure, either total thyroidectomy or less than total thyroidectomy, depending on the recommendation of the surgeon.
  2. Patient is monitored closely in the recovery room for any immediate complications such as bleeding, infection, or damage to surrounding structures.
  3. Patient may experience temporary hoarseness, difficulty swallowing, or low calcium levels immediately after the surgery.
  4. Patient is discharged from the hospital within a few days and instructed on postoperative care, medication management, and follow-up appointments.
  5. Patient undergoes regular follow-up visits to monitor thyroid hormone levels, assess for recurrence of BMNG, and address any complications such as hypoparathyroidism or damage to the recurrent laryngeal nerve.
  6. Patient may require lifelong thyroid hormone replacement therapy if the entire thyroid gland was removed.

What to Ask Your Doctor

Questions a patient should ask their doctor about thyroidectomy include:

  1. What are the potential risks and complications associated with total thyroidectomy and less than total thyroidectomy?
  2. How likely is it that my multi-nodular thyroid condition will come back after total thyroidectomy compared to less than total thyroidectomy?
  3. What is the likelihood of needing additional surgery in the future if I choose total thyroidectomy versus less than total thyroidectomy?
  4. How common is temporary and permanent damage to the recurrent laryngeal nerve with both total thyroidectomy and less than total thyroidectomy?
  5. What are the chances of developing temporary and permanent hypoparathyroidism with total thyroidectomy versus less than total thyroidectomy?
  6. How will my quality of life be impacted by each procedure in the long term?
  7. Are there any other treatment options besides total thyroidectomy and less than total thyroidectomy that I should consider?
  8. What is the experience of the surgical team in performing total thyroidectomy and less than total thyroidectomy procedures?
  9. How long is the recovery period expected to be for each procedure?
  10. Are there any specific factors about my individual health or condition that may make one procedure more suitable for me than the other?

Reference

Authors: Bharath S, Yadav SK, Sharma D, Jha CK, Mishra A, Mishra SK, Shekhar S. Journal: Langenbecks Arch Surg. 2023 May 19;408(1):200. doi: 10.1007/s00423-023-02941-1. PMID: 37204607