INTRODUCTION: Preservation of thyroid tissue in surgeries for multinodular goiter (MG) does not avoid hormonal replacement and may have nodular recurrence. Reoperations have a complication rate 20 times higher. We propose total thyroidectomy (TT) for MG as a definitive treatment. OBJECTIVE: To evaluate and justify the TT in patients with MG. MATERIAL AND METHOD: Retrospective study of 1,789 patients who underwent thyroidectomies, from 06/90 to 12/00. Indication, extension of thyroidectomy, cancer incidence and complications were analyzed. RESULTS: TT was performed in 81.2% of 872 patients with nontoxic and 93.9% of 33 with toxic MG and 93.9% of 66 with recurrent goiter. Transient and permanent hypoparathyroidism, hematoma, transient and permanent recurrent laryngeal nerve injury occurred in 11.5%, 0.5%, 0.4%, 2.7% and 0.2% of the patients with nontoxic MG and 8.3%, 8.3%, zero, 5.0% and 5.0% of those with recurrent goiter. Permanent complication of TT for non-toxic MG was similar to non-total thyroidectomy. Utilization of TT for non-toxic MG increased from 53.3% to 93.6% at present, with a concomitant increase of cancer diagnosis from 11.1% to 19.8%. CONCLUSION: TT is the treatment of choice for MG, when there is bilateral gland involvement posterior to middle thyroid veins, because it decreases the likelihood of future reoperations and associated risks due to recurrent disease, when performed safely.
Multinodular goiter; Benign thyroid disease; Total thyroidectomy
