Total thyroidectomy is the preferred procedure for thyroid disease as it eliminates the risk of recurrence and reduces complications compared to lesser resection. While historically total thyroidectomy was abandoned due to risks of hypothyroidism, modern techniques like capsular dissection have reduced risks of nerve or parathyroid damage to levels similar to subtotal resection, with benefits of eliminating disease and reducing reoperation rates. The author's experience of over 300 cases found low rates of transient hypocalcemia but very low permanent nerve or parathyroid complications.

1. Total Thyroidectomy for
Non-Malignant goiter
Javed Iqbal, FCPS,FRCS
Professor of surgery
Quaid-e-Azam Medical College,
Bahawalpur

2. Total thyroidectomy is the
procedure of choice for
thyroid malignancy

3. Commonly performed procedures
for non-malignant thyroid:
 Lobectomy
 Lobectomy with isthamectomy
 Sub-total thyroidectomy
 Total Thyroiectomy

4. Sub-total thyroidectomy is
commonly performed because:
 It is thought that it is associated with low
incidence of RNL damage
 It is thought that the chances of
parathyroid damage is less
 Of the fear that total thyroidectomy will
need permanent replacement therapy
 It is easier to perform then total
thyroidectomy

5. Problems with lesser resection
 Significant chances of recurrence (up to
23% in MNG)
 Small but Significant number of MNG have
been found to have tiny foci of Malignancy
 Thyrotoxicosis can also reoccur and
specially the ophthalmopathy may stay or
even progress after lesser resection

6. The mid-term freedom rate
from thyroid nodule
recurrence or parenchymal
irregularity after lobectomy
for solitary nodule of the
thyroid is unsatisfactory.

11. Theodore Kocher performed the
first total thyroidectomy for MNG
with very good results and
thought it to be the procedure of
choice in 1909
mortality less than 0.18%
minimal risk to RNL and
Parathyroids

12. He, however abandoned
this procedure due to post-
operative hypothyroidism
As the thyroid extract was made
much later
Thyroxine was available in 1913

13. Capsular dissection
technique
1992….Professor Reeve and
Professor Delbridge

14.  Total thyroidectomy is now the preferred option for the surgical
management of Graves disease," ANZ Journal of Surgery, Volume
72 Issue 5 Page 321 - 2002
 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 .00000[Benign diseases of
the thyroid: indications for surgical treatment and the current role of
total thyroidectomy ]Chir Ital 2003 Mar-Apr;55(2):179-87

15.  Total thyroidectomy for management of
thyroid disease.World J Surg 2000
Aug;24(8):962-5 (ISSN: 0364-2313)
 A comparison of total thyroidectomy
and lobectomy in the treatment of
dominant thyroid nodules. Am Surg
2002 Aug;68(8):678-82; discussion
682-3 Farkas EA; King TA; Bolton JS;
Fuhrman GM

16.  Assessment of the morbidity and complications
of total thyroidectomy .Arch Otolaryngol
Head Neck Surg 2002 Apr;128(4):389-
92 (ISSN: 0886-4470
 [Total thyroidectomy in the surgical treatment
of thyroid disease a retrospective clinical study]
[La tiroidectomia totale nel trattamento della
patologia tiroidea.]Minerva Endocrinol 2001
Jun;26(2):41-51 (ISSN: 0391-1977)

17.  Total thyroidectomy for the treatment of
hyperthyroidism in patients with
ophthalmopathy. Thyroid 2002
Mar;12(3):265-7 (ISSN: 1050-
7256) Kurihara H
Kurihara Thyroid Clinic, Morioka, Japan.
 [Basedow disease. From subtotal to total
thyroidectomy ] [Morbus Basedow. Von
subtotaler zu totaler Thyreoidektomie.] Schweiz
Rundsch Med Prax 2002 Feb
6;91(6):206-15 (ISSN: 1013-
2058) Gemsenjager E; Valko P; Schweizer I
Chirurgische Klinik, Spital Zollikerberg,
Zollikerberg.

18.  Indications, risks, and acceptance oftotal
thyroidectomy for multinodular benign
goiter.Surg Today 2001;31(11):958-
62
 Surgery for Graves' disease: total versus
subtotal thyroidectomy -results of a
prospective randomized trial.World J
Surg 2000 Nov;24(11):1303-11

19.  [Benign thyroid disease: 20-year experience in
surgical therapy][Malattia tiroidea benigna:
esperienza ventennale di terapia
chirurgica.]Chir Ital 2000 Jan-
Feb;52(1):41-7 (ISSN: 0009-4773)
 Complications of total thyroidectomy :
incidence, prevention and treatment]
[Complicanze della tiroidectomia totale:
incidenza, prevenzione e trattamento.]Chir Ital
2002 Sep-Oct;54(5):635-42 (ISSN: 0009-
4773)

20.  Complication rates after operations for
benign thyroid disease. Acta
Otolaryngol 2002 Sep;122(6):679-
83 (ISSN: 0001-6489) Dener C
Department ol Surgery, Fatih University
School of Medicine, Ankara, Turkey.
 High rate of recurrence after lobectomy for
solitary thyroid nodule. Eur J Surg
2002;168(7):397-400 (ISSN: 1102-
4151) Marchesi M; Biffoni M; Faloci C;
Biancari F; Campana FP
3rd Department of Surgery, University La
Sapienza, Rome, Italy.

21.  Total thyroidectomy : the procedure of
choice for multinodular goitre.Eur J Surg
2002;168(3):196; Kaushal M;
Agarwal G; Mishra SK
 Total Thyroidectomy: A study of 58 cases:
Javed Iqbal, Babar Ali and Haroon K.
Pasha: 1997 JCPSP Vol. 7 (1) 20-21

22. Acceptable results
 RLN peresis 2.4%
 RNL damage
0.8%
 Transient hypocalcaemia 4.2%
 Long standing Hypocalcaemia 1.4%
These results are not different from
patients who underwent lesser
resection studies

23. 1995-2003
n-more than 300

24. TOUCH WOOD
 NO RLN damage
 3.7% transient Hypocalcaemia
 2 patient with long standing
Hypocalcaemia

25. Conclusions
 No chances of recurrence
 Lesser resection has no influence on post-
operative thyroxine therapy
 Chances of missing a focus of malignancy
is eliminated.
 The total resection has better effect of
progression of Ophthalmopathy in Toxic
goiter

26. Conclusions
 With capsular dissection technique the
incidence of damage to RLN and
Parathyroids is comparable with that of
sub-total resection