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A Randomized Trial of Hemithyroidectomy Versus Dunhill for the Surgical Management of Asymmetrical Multinodular Goiter

Sancho, Juan J. MD*; Prieto, Rosa MD*; Dueñas, Juan P. MD*; Ribera, Carles MD; Ripollés, Joaquim MD; Larrad, Álvaro MD; Sitges-Serra, Antoni MD, FRCS*

doi: 10.1097/SLA.0b013e318272df62
Original Articles From the ESA Proceedings
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Objective: To assess the immediate and long-term clinical results of 2 different surgical procedures for the treatment of asymmetrical multinodular goiter (AMG).

Background: Half of the patients presenting with a single benign thyroid nodule have contralateral subclinical disease. There is a controversy whether these patients should be treated with hemithyroidectomy (HMT) or with a more extensive procedure.

Methods: Adult patients with a benign unilateral dominant nodule and contralateral nodule(s) with a diameter of less than 10 mm detected on neck ultrasonography were randomized to HMT or Dunhill (DUN). Rates of complications, remnant growth, incidental carcinoma, and reoperation were assessed.

Results: A total of 118 patients (F/M:110/8, mean age 43 years) were included and randomized: 65 to HMT and 53 to DUN. After randomization, 28 patients were excluded leaving 47 HMT and 43 DUN long-term (55 ± 35 months) evaluable patients. Mean nodule size was 38 and 6 mm for the dominant and contralateral nodules, respectively. No differences were found in operative time, accidental parathyroidectomy, parathyroid autotransplantation, or wound complications. Transient hypocalcemia was more common in DUN (30% vs 8%; P < 0.001). No permanent complications were observed. At the last follow-up visit, thyroid-stimulating hormone was similar in both groups. Remnant growth (20 vs 0%; P < 0.001), appearance of new nodules (55 vs 14%; P < 0.001), and overall reoperation rate (9.2 vs 1.8%, P = 0.2) were more common in HMT, mostly because of undiagnosed cancer requiring completion thyroidectomy. Thirty percent of HMTs developed hypothyroidism and required long-term T4 supplementation.

Conclusions: DUN appears superior to HMT for the treatment of AMG in terms of early reoperation for missed carcinomas and disease progression. Both procedures have a similarly uneventful postoperative course.

Lobectomy and Dunhill have a similar immediate postoperative outcome. Reoperations are more common after lobectomy. Remnant growth is 20% at 5 years after lobectomy whereas no disease progression is observed after Dunhill. One third of lobectomy patients require long-term treatment with thyroxine.

*Endocrine Surgery Unit, Hospital del Mar, Barcelona

Hospital de Sant Joan, Martorell

Clínica del Rosario, Madrid, Spain.

Reprints: Antoni Sitges-Serra, MD, FRCS, Endocrine Surgery Unit, Hospital del Mar, Passeig Marítim 25–29, 08003 Barcelona, Spain. E-mail: asitges@hospitaldelmar.cat.

Disclosure: The authors declare no conflicts of interest.

© 2012 Lippincott Williams & Wilkins, Inc.