Comparison of Complications between Total and Near-Total Thyroidectomy in Non-Toxic Multinodular Goiter Patients

Abstract

Thyroid diseases are common in Bangladesh. Surgical management for multinodular goiter (MNG) include subtotal thyroidectomy, total thyroidectomy (TT), and near-total thyroidectomy (NTT). NTT involves removal of all grossly visible thyroid tissue, leaving a small remnant adjacent to the recurrent laryngeal nerve near Berry's ligament. A prospective, observational study was conducted in the Department of Otorhinolaryngology and Head-Neck Surgery of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, between January 2018 and July 2019, to compare post-operative complications of total and near-total thyroidectomy in non-toxic multinodular goiter patients. A total of 36 patients with non-toxic MNG were enrolled; 18 patients undergoing total thyroidectomy and 18 patients undergoing near-total thyroidectomy were selected through purposive non-randomized sampling method. All operations were performed under general anesthesia by highly experienced surgeons (at least associate professor rank having ≥10 years experience). Then serum calcium, serum PTH, intact PTH, and fibre-optic laryngoscopy were assessed at 1st and 7th post-operative days and follow-up after 1 month, and 3 months. Their mean age of the patients was 50.7±7.12 years; 30(83.3%) patients were female. We observed more clinical tetany (44.4% vs. 11.1%; p=0.025), more hypocalcemia (38.8% vs. 5.5%; p=0.04), more incidence of recurrent laryngeal nerve (RLN) palsy (33.3% vs. 5.5%; p=0.035) and more hypoparathyroidism (33.3% vs. 5.5%; p=0.035) in total thyroidectomy compared to near-total thryroidectomy among our study patients. Regarding preservation of the parathyroids, ≥3 glands were preserved intra-operatively in 72.2% of patients in NTT procedure, while only 33.3% of patients in TT procedure (p=0.019). The mean post-operative hospital stay was found more in total thyroidectomy (5.44±0.90 vs. 4.56±0.62 days; p=0.001).  Our data suggests that NTT carries significantly fewer post-operative complications and less hospital stay than that of TT and should be considered the preferred surgical strategy for non-toxic multinodular goiter. 

CBMJ 2026 July: Vol. 15 No. 02 P:385-389