Surgery for recurrent goiter: complication rate and role of the thyroid-stimulating hormone-suppressive therapy after the first operation

• Published in: Langenbeck's archives of surgery Vol. 400; no. 2; pp. 253 - 258
• Main Authors: Miccoli, P., Frustaci, G., Fosso, A., Miccoli, M., Materazzi, G.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2015
• Subjects: Abdominal Surgery; Adolescent; Adult; Age Factors; Aged; Cardiac Surgery; Child; Cohort Studies; Female; Follow-Up Studies; General Surgery; Goiter - drug therapy; Goiter - pathology; Goiter - surgery; Humans; Hypothyroidism - drug therapy; Hypothyroidism - etiology; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Recurrence; Reoperation - methods; Retrospective Studies; Risk Assessment; Severity of Illness Index; Sex Factors; Thoracic Surgery; Thyroid Function Tests; Thyroidectomy - adverse effects; Thyroidectomy - methods; Thyroxine - administration & dosage; Time Factors; Traumatic Surgery; Treatment Outcome; Vascular Surgery; Young Adult; Therapy; TSH-suppressive; Complication; Recurrent; Goiter
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-014-1258-7

Purpose
This report examines outcomes in our series of patients who underwent surgery for recurrent goiter to assess the efficacy of thyroid-stimulating hormone (TSH)-suppressive therapy after the first less than total thyroidectomy. A further outcome was to understand whether redo surgery was burdened with a higher rate of complications.
Methods
We evaluated 214 patients undergoing a completion thyroidectomy for recurrent goiter who had received, as their first surgery, a bilateral subtotal thyroidectomy. After the first operation, 84 patients were given TSH-suppressive therapy with levothyroxine, 32 were treated with antithyroid drugs, and 92 did not receive any suppressive treatment but only a substitutive therapy. The 84 patients who received levothyroxine at a suppressive dosage (group A) were compared with 92 patients who did not receive levothyroxine or received it only at substitutive dosage (group B). We further compared the complication rate of a similar group of 175 patients who had undergone a primary thyroidectomy.
Results
The average age at intervention for relapse in group A patients was significantly lower than that of group B patients: 54.18 vs 60.8 years (
p
 < 0.001). The average interval between the first intervention and the intervention for relapse was significantly shorter in group A than in group B: 24 vs 27 years (
p
 = 0.03). After the operation, temporary hypoparathyroidism occurred in 37.7 % of patients and definitive hypoparathyroidism in 7.2 %.
Conclusions
Our results clearly show that the interval between the two surgical interventions was significantly reduced in patients undergoing TSH-suppressive therapy with levothyroxine. The incidence of hypoparathyroidism dramatically increased.