[Thyroidectomy. A prospective assessment of hemithyroidectomy].

AIM

The results of hemithyroidectomy and total thyroidectomy were assessed in a prospective study. Total thyroidectomy was compared to hemithyroidectomy and contralateral resection. The rate of vocal cord palsy, hypocalcaemia, changes in PTH, and the frequency of sequelae were used to monitor the results.

MATERIAL AND METHODS

One hundred and twenty patients underwent hemithyroidectomy for unilateral thyroid lesions and 80 hemithyroidectomy contralateral resection (35 patients) or total thyroidectomy (45 patients) for bilateral disease. Plasma calcium and PTH were measured pre- and post-operatively, and the need for calcium and vitamin D supplementation was registered.

RESULTS

No permanent vocal cord palsy was encountered. Calcium substitution was not needed after hemithyroidectomy but for more than one year in 9% after hemithyroidectomy and contralateral resection, and in 7% after total thyroidectomy (NS). One needed substitution 2 years after total thyroidectomy. Pre- and postoperative plasma-PTH was found unchanged after hemithyroidectomy and after total thyroidectomy.

DISCUSSION

Hemithyroidectomy and total thyroidectomy are safe procedures with few side effects, if a meticulous dissection is performed. Hypocalcaemia following bilateral operations is usually transient and the need for calcium and vitamin D supplementation is low and usually related to the underlying disease rather than to the operation. Total thyroidectomy will remove the target organ for the immune response in patients with hyperthyroidism and the risk of toxic ophthalmopathy is minimised. Lastly, the risk of recurrent disease is eliminated. Six per cent had minor and probably transient local complaints at control three months after the operation.