Recurrent Goiter Clinical Trial
Official title:
Five-year Follow up of a Randomized Clinical Trial of Unilateral Thyroid Lobectomy With or Without Levothyroxine Treatment Postoperatively
The aim of this study was to compare the prevalence of recurrent nodular goiter in the contralateral thyroid lobe among patients after unilateral thyroid lobectomy for unilateral multinodular goiter receiving versus not receiving prophylactic levothyroxine treatment postoperatively in a five-year follow-up of a randomized study
It is commonly accepted that in patients with benign nodular thyroid disease who undergo
operative therapy, surgical resection consists of lobectomy for patients with disease
limited to one lobe. Contralateral disease is excluded in such cases by preoperative
palpation, ultrasonography of the neck, and intraoperative palpation. On the other hand, the
preferred operative procedure for bilateral nodular thyroid disease is total thyroidectomy.
Such a treatment strategy minimizes the risk of development of recurrent disease and
diminishes the risk of complications when reoperation for recurrent nodular thyroid disease
becomes necessary. The recurrence rate for unilateral thyroidectomy of benign nodular goiter
performed by expert surgeons has been reported to vary from 10% to 26%. Potential risk
factors for recurrence of nodular goiter have been evaluated in many studies and include:
young age at presentation, female gender, positive family history of goiter, long duration
of symptoms, mutinodularity of thyroid disease, high volume of left thyroid tissue. However,
most studies evaluating the incidence of recurrent nodular disease are retrospective, and it
is difficult to determine whether the recurrence represents de novo nodule formation in a
previously normal thyroid remnant or progression of residual disease left at initial
operation.
It is well known fact, that most patients after thyroid lobectomy are euthyroid (60%-90%)
and do not require thyroid hormone replacement therapy. However, it is an important question
whether thyroid hormone administration postoperatively can prevent recurrent nodular thyroid
disease in euthyroid hemithyroidectomized patients? The aim of the present randomized study
was to compare the prevalence of recurrent nodular goiter in the contralateral thyroid lobe
among patients after unilateral thyroid lobectomy for unilateral multinodular goiter (MNG)
receiving versus not receiving prophylactic levothyroxine (LT4) treatment postoperatively in
a five-year follow-up.
;
Observational Model: Case Control, Time Perspective: Prospective