[The surgical treatment of autonomous nodular goiter. Prospective long-term study].

In a prospective study 287 patients with a nodular goiter and preclinical or overt hyperthyroidism (TRH-TSH unresponsiveness) underwent selective excision of the nodular goitrous tissue to prevent continuing growth and goiter recurrence and reduce concomitantly the autonomously functioning follicular tissue. Depending on the topographic location of the nodes, hilar dissection (hemithyroidectomy or extrathyroidal excision) was carried out in 44% of the patients instead of classic subtotal resection. The operative mortality was nil and the rate of recurrent nerve palsy was 2.1% of cases and 1.3% of nerves at risk respectively; in no instance did bilateral palsy or permanent hypoparathyroidism occur. Thyroid function was investigated one or more times during a period lasting from 3 months to 18 years postoperatively. One patient (0.6%) developed recurrent hyperthyroidism, and in 5 subjects euthyroid TRH-TSH unresponsiveness persisted during an observation period lasting 8-13 years postoperatively. Preclinical or overt hypothyroidism occurred depending upon the extension of goiter resection, i.e. upon the extension of nodular goitrous transformation: hypothyroidism occurred in none of the patients with unifocal (uninodular) autonomy. In 58% of patients with less than or equal to 10 g of residual thyroid tissue, and in 19% of patients with a greater than 10 g thyroid remnant, substitution with thyroxine was necessary. In 2 (2.4%) of the patients followed up for 5-18 (x = 10 +/- 3) years a goiter recurrence (euthyroid) necessitating resection developed 9 and 12 years respectively after resection of a toxic uninodular goiter.(ABSTRACT TRUNCATED AT 250 WORDS)