Does goitre size and delayed surgical intervention adversely affect surgical outcome? A multi-centric experience on thyroidectomy

Abstract

Background: Patients with Grade 2 goiters are followed up nonoperatively. Surgical anatomy is altered as nodules/goiter increases to Grade 3. The aim of the study was to analyze the results of thyroidectomy on Grade 2 versus Grade 3 goiter in terms of intra-operative surgical difficulty and surgical outcomes. Materials and Methods: Multi-centric cross-sectional analytical study. Retrospective analysis of the operative records of the patients undergoing transcervical total thyroidectomy (TT) from 2010 to 2019, satisfying the inclusion and exclusion criteria were included. Based on goiter size, patients were grouped as Group A and B. The important surgical landmarks and surgical outcomes were compared. Results: Of 2825 cases included, 1697 patients had Grade 2 and 1128 had Grade 3 goiter. In Group A, 1325 underwent TT and 372 underwent hermithyroidectomy (HT). In Group B, 965 had TT and 163 had HT. Group B patients were older and had a longer duration of goiter. In Group A, 3022 recurrent laryngeal nerves (RLN), 3022 external branches of superior laryngeal nerve (EBSLN) and 6044 parathyroid positions, and in Group B, 2093 RLNs, 2093 EBSLNs, and 4186 parathyroid positions were analyzed. Group B had more incidences of “Type C” relationship between RLN and ligament of Berry. EBSLN was Type II in 62% of Group B and 25.5% of Group A. Tubercle of Zuckerkandl was Grade 2/3 in Group B. Group B had longer cervical incisions, more parathyroid auto-transplantation, increased flap edema, seroma, voice change, temporary RLN palsy and hypoparathyroidism. Conclusion: Early surgery at grade 2 before it progresses to grade 3 goiter appears to have better surgical outcome.

Keywords

• delayed surgery and thyroidectomy outcome
• grade of goiter
• hypoparathyroidism
• recurrent laryngeal nerve