Total versus hemi-thyroidectomy for solitary nodular goitres - A retrospective hospital based comparative study

Surgery for thyroid disorders are of several types depending on the amount of tissue that is left behind rather than the amount of tissue that is actually removed. In this regard, the thyroid surgeries that are widely practiced at present are total thyroidectomy, near-total thyroidectomy, hemithyroidectomy and the recent advance being the laparoscopic procedures. Though the type of surgery that is required depends on the anatomical diagnosis, consideration of the pathological diagnosis is essential before planning for surgery.Doing a total thyroidectomy for a benign solitary nodule of thyroid which is considered as over treatment, becomes the standard of care if the postop HPE proves it to be malignant and a hemithyroidectomy if done for the same patient might become an undertreatment.As there are no standardised institutional protocol for the management of solitary nodular thyroid, a retrospective analysis was done on 60 patients who had solitary nodule thyroid, half of whom underwent total thyroidectomy and 30 others who underwent hemithyroidectomy for the same.The main objective of this study is to compare the complication rates between total and hemi thyroidectomy for solitary nodule goitre. All the patients were preoperatively workedup which includedthyroid function test, ultrasound of neck and FNAC of the nodule. A comparative analysis was done based on the complication rates of the 2 procedures (Total and Hemithroidectomy). Though the incidence of clinically significant nerve injury was same in both, the need for resurgery was there in 9% of patients who underwent hemithyroidectomy. The other justifications for total thyroidectomy were based on intraoperative presence of nodules in the opposite lobe, incidence of malignancy, incidence of recurrence, difficulty of resurgery, patients losing followup, easier postoperative titration of thyroxine with total thyroidectomy and the pathological evidence in support of total thyroidectomy. In spite of all these, larger prospective trials with long term follow up is required to decide upon the standard of care for such patients.