RECURRENT LARYNGEAL NERVE INJURY IN TOTAL VERSUS SUBTOTAL THYROIDECTOMY
Abstract
Background: Both Total and Subtotal Thyroidectomy are correct treatment options for symptomatic Euthyroid Multinodular Goitre. The choice depends upon surgeon’s preference due to consideration of disadvantages like permanent hypothyroidism in Total Thyroidectomy and high chances of recurrence in Subtotal Thyroidectomy. Many surgeons believe that there is a higher incidence of Recurrent Laryngeal nerve injury in Total Thyroidectomy which affects their choice of surgery. This study aimed to compare the incidence of recurrent laryngeal nerve injury in total versus subtotal thyroidectomy. Methods: This non randomized controlled trial was carried out at Department of Surgery and ENT of Ayub Teaching Hospital Abbottabad, and Combined Military Hospital Rawalpindi from 1st September 2013 to 30th August 2014. During the period of study, patients presenting in surgical outpatient department with euthyroid multinodular goitre having pressure symptoms requiring thyroidectomy were divided into two groups by convenience sampling with 87 patients in group 1 and 90 patients in group 2. Group-1 was subjected to total thyroidectomy and Group -2 underwent subtotal thyroidectomy. All the patients had preoperative Indirect Laryngoscopy examination and it was repeated postoperatively to check for injury to the recurrent laryngeal nerve. Results: A total of 177 patients were included in the study. Out of these, 87 patients underwent total thyroidectomy (Group-1). Two of these patients developed recurrent laryngeal nerve injury (2.3%). In group-2 subjected to subtotal thyroidectomy, three of the patients developed recurrent laryngeal nerve injury (3.3%). The p-value was 0.678. The overall risk of injury to this nerve in both surgeries combined was 2.8%. Conclusion: There is no significant difference in the risk of recurrent laryngeal nerve damage in patients undergoing total versus subtotal thyroidectomy.Keywords: Total thyroidectomy, subtotal thyroidectomy, recurrent laryngeal nerve injuryReferences
Majid MA, Siddique MI. Major post-operative complications of thyroid surgery: preventable or not? Bangladesh Med Res Counc Bull 2008;34(3):99–103.
Dralle H, Lorenz K, Machens A. Verdicts on malpractice claims after thyroid surgery: emerging trends and future directions. Head Neck 2012;34(11):1591–6.
Canbaz H, Dirlik M, Colak T, Ocal K, Akca T, Bilgin O, et al. Total thyroidectomy is safer with identification of recurrent laryngeal nerve. J Zhejiang Univ Sci B 2008;9(6):482–8.
Efremidou EI, Papageorgiou MS, Liratzopoulos N, Manolas KJ. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: A review of 932 cases. Can J Surg 2009;52(1):39–44.
Delbridge L, Guinea AI, Reeve TS. Total thyroidectomy for bilateral benign multinodular goiter: effect of changing practice. Arch Surg 1999;134(12):1389–93.
Zakaria HM, Al Awad NA, Al Kreedes AS, Al-Mulhim AM, Al-Sharway MA, Hadi MA, et al. Recurrent Laryngeal Nerve Injury in Thyroid Surgery. Oman Med J 2011;26(1):34–8.
Colak T, Akca T, Kanik A, Yapici D, Aydin S. Total versus subtotal thyroidectomy for the management of benign multinodular goiter in an endemic region. ANZ J Surg 2004;74(11):974–8.
Röjdmark J, Järhult J. High long term recurrence rate after subtotal thyroidectomy for nodular goitre. Eur J Surg 1995;161(10):725–7.
Ali MA, Raziq S, Khan WA, Majeed S. Total thyroidectomy for multi – nodular goiter. Pak Armed Force Med J 2011;6(1).
Hokkam ENM. Total or subtotal thyroidectomy in the management of multinodular goiter. Suez Canal Univ Med J 2007;10(2):139–46.
Varaldo E, Ansaldo GL, Mascherini M, Cafiero F, Minuto MN. Neurological complications in thyroid surgery:a surgical point of view on laryngeal nerves. Front Endocrinol (Lausanne) 2014;5:108.
Bage A, Bage N, Anand K. Vijayasundaram, “Total thyroidectomy versus subtotal thyroidectomy in multinodular goitre—our experience,” Internet J Otorhinolaryngol 2012;14(1):1–7.
Ozbas S, Kocak S, Aydintug S, Cakmak A, Demirkiran MA, Wishart GC. Comparison of the complications of subtotal, near total and total thyroidectomy in the surgical management of multinodular goiter. Endocr J 2005;52(2):199–205.
Liu Q, Djuricin G, Prinz RA. Total thyroidectomy for benign thyroid disease. Surgery 1998;123(1):2–7.
Colak T, Akca T, Kanik A, Yapici D, Aydin S. Total versus subtotal thyroidectomy for the management of benign multinodular goiter in an endemic region. ANZ J Surg 2004;74(11):974–8.
Marchesi M, Biffoni M, Tartaglia F, Biancari F, Campana FP. Total versus subtotal thyroidectomy in the management of multinodular goiter. Int Surg 1998;83(3):202–4.
Pappalardo G, Guadalaxara A, Frattaroli FM, Illomei G, Falaschi P. Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports. Eur J Surg 1998;164(7):501–6.
Imad S, Israr M, Ali M. Frequency of malignancy in multinodular goitre: a review of 80 cases of multinodular goiter. Pak J Surg 2013;29(1):9–12.
Wilhelm SM, McHenry CR. Total thyroidectomy is superior to subtotal thyroidectomy for management of graves’ disease in the united states. World J Surg 2010;34(6):1261–4.
De Roy van Zuidewijn DB, Songun I, Kievit J, van de Velde CJ. Complications of thyroid surgery. Ann Surg Oncol 1995;2(1)56–60.
Tezelman S, Borucu I, Senyuek Giles Y, Tunca F, Terzioglu T. The change in surgical practice from subtotal to near-total or total thyroidectomy in the treatment of patients with benign multinodular goiter. World J Surg 2009;33(3):400–5.
Downloads
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
