[Surgical treatment of goiter at a central hospital. A consecutive adjustment after changes in the organization, strategy and surgical techniques].

The aim of the study was to analyze the frequency of complications following thyroid gland surgery in a surgical department of a district hospital. Since the results of the department were last evaluated in 1988, changes in surgical strategy and operative techniques have been introduced. Hemithyroidectomy with resection of the glandular isthmus is now the least comprehensive operation performed, and at all operations the recurrent laryngeal nerve is identified and exposed. One hundred and twenty-five operations were carried out over a five years period. Half of the patients were operated for non-toxic nodular goitre, and 24 patients for thyrotoxicosis. Of 23 patients with a scintigraphically "cold" nodule, four turned out to have carcinoma. The frequency of permanent complications were 0.8% (hypoparathyroidism in one patient). Transient hypoparathyroidism was seen in 2%, and in four patients (3%) transient unilateral nerve palsy developed. No cases of permanent or bilateral vocal cord paralysis were found. Remaining complications were haemorrhage (2%) and one patient with a complication not related to surgery (0.8%). The departments results have improved significantly since 1988, and it is concluded that uncomplicated thyroid gland surgery may safely be performed at a district hospital.