Total Thyroidectomy: The Procedure of Choice for Toxic Goitre

OBJECTIVE Over the years, subtotal thyroidectomy has been the mainstay of treatment for toxic goitre; however, total thyroidectomy is increasingly being considered as the procedure of choice. This study aimed to review our experience with total thyroidectomy in toxic goitre and evaluate the outcome of this procedure. METHODS A total of 67 consecutive patients who were diagnosed with toxic goitres and had total thyroidectomy from January 2003 to February 2005 were included in this prospective open study. The preoperative diagnosis in all patients was benign goitre. The surgical outcomes were reviewed with regard to mortality and morbidity. RESULTS A standardized operative technique was adopted and practiced among all surgeons in our department. Of the 67 patients with toxic goitre, 36 (53.7%) patients had toxic multinodular goitre (Plummer's disease) and 31 (46.3%) patients had diffuse goitre (Graves' disease). Although there were no documented injuries to the recurrent laryngeal nerves, one patient had temporary hoarseness of voice. In our series of total thyroidectomy, 18 patients (26.8%) developed transient hypocalcaemia but only one patient (1.5%) had persistent hypocalcaemia. Four (5.9%) patients had occult papillary thyroid cancer and one patient (1.5%) had Hashimoto's thyroiditis discovered on histological examination. There were no other postoperative complications except for wound infection in one patient (1.5%). CONCLUSION Total thyroidectomy should be considered as the procedure of choice for toxic goitres. It is paramount that sufficient attention be paid to the preservation of the laryngeal nerves and the parathyroid glands.