Med Bull Sisli Etfal Hosp. 2013; 47(2): 74-78 | DOI: 10.5350/SEMB2013470206

Comparison of early and late results of total and subtotal thyroidectomy for benign thyroid disease

Kemal Arslan, Ersin Turan, Mehmet Ali Eryýlmaz, Emet Ebru Nazik, Osman Doðru
Konya Eðitim ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Konya-Türkiye

Background: Recently, total thyroidectomy (TT) has been performed and suggested in benign thyroid disease. But it was reported that the complications of total thyroidectomy was more than bilateral subtotal thyroidectomy (BST) this is still a topic of debate. Purpose of the present study is comparison of complications of BST and TT operations in treatment of benign thyroid disease.
Materials and Methods: Early and late complications of TT and BST operations were retrospectively evaluated, which were performed in General Surgery Clinic of Konya Training and Research Hospital inbetween 2004-2008.
Results: The study involved 96 patients in BST group and 110 patients in TT group. Follow-up period was 69.4±8.3 months in BST group, 52.7±5.3 months in TT group. Transient hypocalcemia were detected in 10 patients (9.1%) in BST group and 7 patients (7.3%) in TT group. Transient recurrent laryngeal nerve paralysis developed in 12 patients (7.2%); 5 patients (5.2%) in BST group and 7 patients (6.4%) in TT group. Hematoma in 4 patients (4.2%), seroma in 3 patients (3.1%), flap edema in 5 patients (5.2%) occured in BST group. In TT group, there had been; hematoma in 1 patients (1.0%), seroma in 5 patients (4.5%), flap edema in 4 patients (4.5%).
Permanent hypocalcemia occured in 2 patients (2.1%) in BST group and 3 patients (2.7%) in TT group. Permanent recurrent laryngeal nerve paralysis developed in 1 patient (1.0%) in BST group and 2 patients (1.5%) in TT group. There was no statistically significant difference inbetween the groups about complications and demographic characteristics. Recurrence was seen in 6 patients (6.3%) in BST group.
Discussion and Conclusion: TT not increase early and late complications in bengn thyroid diease requiring sugery. BSThas arisk of recurrenceaftersurgeryand thereforemust be carried outagain. Complications in secondary thyroidectomy in patients with prior thyroid surgery are very high.Therefore, if surgery is necessary in benign thyroid diseases should be TT.

Keywords: Subtotal thyroidectomy, total thyroidectomy, paralysis of recurrent laryngeal nerve, hypocalcemia

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Selim tiroid hastalýklarýnýn cerrahi tedavisinde subtotal ve total tiroidektominin erken ve geç dönem sonuçlarýnýn karþýlaþtýrýlmasý

Kemal Arslan, Ersin Turan, Mehmet Ali Eryýlmaz, Emet Ebru Nazik, Osman Doðru
Konya Eðitim ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Konya-Türkiye

Amaç: Son yýllarda benign tiroid hastalýklarýnda total tiroidektomi (TT) uygulanmakta ve önerilmektedir. Ancak TT’nin komplikasyonlarýnýn bilateral subtotal (BST)’den daha fazla olduðu bildirilmiþ ve bu endiþe halen devam etmektedir. Bu çalýþmanýn amacý selim tiroidektomi hastalýklarýnýn tedavisinde TT ile BST ameliyatlarýnýn erken ve geç dönem komplikasyonlarýnýn karþýlaþtýrýlmasýdýr.
Gereç ve Yöntem: Konya Eðitim ve Araþtýrma Hastanesi Genel Cerrahi Kliniðinde 2004-2008 yýllarý arasýnda yapýlan BST ve TT ameliyatlarýnýn erken ve geç dönem komplikasyonlarý incelendi.
Bulgular: BST grubunda 96, TT grubunda 110 hasta çalýþmaya alýndý. Takip süresi BST grubunda 69.4±8.3 ay (60-84), TT grubunda 52.7±5.3 ay (48-60) idi ve BST grubunda daha uzundu. En sýk tespit edilen komplikasyon geçici hipokalsemi idi. Hipokalsemi BST grubunda 10 hastada (%9.1), TT grubunda 7 hastada (%7.3) saptandý. Geçici rekürren laringeal sinir paralizisi BST grubunda 5 hastada (%5.2), TT grubunda 7 hastada (%6.4) saptandý. BST grubunda hematom 4 (%4.2), seroma 3 (%3.1), flep ödemi 5 (%5.2) hastada geliþti. TT grubunda hematom 1 (%1.0), seroma 5 (%4.5) ve flep ödemi 4 (%4.5) hastada saptandý. Kalýcý hipokalsemi BST grubunda 2 hastada (%2.1), TT grubunda 3 hastada (%2.7) geliþti. BST grubunda 1, TT grubunda 2 hastada (%1.5) kalýcý rekürrenlaringeal paralizisi geliþti. Demografik özellikler ve komplikasyonlar açýsýndan gruplar arasýnda anlamlý fark yoktu. BST grubunda 6 (%6.3) hastada nüks görüldü.
Tartýþma ve Sonuç: Cerrahi gerektiren selim tiroid hastalýklarýnda TT erken ve geç komplikasyonlarý arttýrmamaktadýr. BST sonrasý nüks ihtimali vardýr ve bu nedenle tekrar ameliyat gerektirebilmektedir. Nüks tiroid ameliyatlarýndan sonra primer ameliyatlara göre komplikasyonlar belirgin þekilde daha fazladýr. Bu nedenle benigntiroid hastalýklarýnda eðer cerrahi gerekliyse TT uygulanmalýdýr.

Anahtar Kelimeler: Subtotal tiroidektomi, total tiroidektomi, rekürren laringeal paralizisi, hipokalsemi

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