RECURRENT NODULAR GOITER PREDICTORS OF RECURRENCE AND OUTCOME AFTER REOPERATION

Objective: To determine the predictors of recurrent nodular goiter and the incidence of complications related to reoperation. Patients and Methods: The study included 25 patients underwent reoperative thyroid surgery for management of recurrent nodular goiter. A matched case-control study of 25 patients operated on for non recurrent nodular goiter at the same period was performed. The assessed parameters include: age and sex, indication for primary and reoperative surgery, interval between primary and reoperative surgery, pathologic findings, duration of reoperative surgery, duration of hospital stay, and postooeprrative complications. The standard operation for strictly unilateral thyroid disease was hemithyroidectomy with resection of the isthmus. A total thyroidectomy was performed in cases of cancer or when nodules were present in both thyroid lobes. Results: The study included 25 patients with recurrent goiter (10 male and 15 female) with mean age of 43±12.2 years. The mean interval between primary and reoperative thyroidectomy was 12±3.5 years. The indication for reoperation was mostly due to an originally misdiagnosed carcinoma (68%). Papillary carcinoma was the most common histopathological type (40%). Age younger than 40 years, presence of multinodular goiter at initial surgery and bilateral surgery were significantly frequent risk factors in patients with recurrent goiter, while multinodular goiter was the only significant independent predictor of the recurrence. Total thyroidectomy was the most frequently performed secondary procedure (84%). The morbidity rate was 16% in patients with reoperative thyroidectomy (temporary hypoparathyroidism in 12% and temporary RLN palsy in 4%). The rate of temporary hypoparathyroidism was 4% in patients with first time thyroidectomy. Conclusion: Presence of multinodular goiter at primary surgery is a predictor of recurrent goiter, thus total thyroidectomy is advisable in these cases which can be done safely as a primary or a secondary procedure with an acceptable rate of complications when standard technical considerations were respected.