STRENGTHS

Published in renowned journal of impact factor of 1.81.

Study was done in tertiary referral medical centre.

Title matching with study.

Aim and objective- clearly defined and matching with title of

study.

Adequate sample size. Key words mentioned. Commonly encountered condition.

Strength
Indication of surgery: mentioned. Surgical technique well elaborated. All surgery were performed by same surgical technique. No extra burden to patients.

Results were well elaborated.

Appropriate statistical tools were applied.

Weakness
Published in 2005.
Retrospective chart review. Ethical clearance from ethical review board. ? Place of auto transplantation of parathyroid gland.

Not adequate follow-up period.

Is primary total thyroidectomy justified in benign multinodular goiter? Results of a prospective quality assurance study of 45 hospitals offering different levels of care]. Thomusch O, Sekulla C, Dralle H., 2003 May;74(5):437-43. Klinik fr Allgemein-,Viszeral- und Gefsschirurgie,MartinLuther-Universitt Halle-Wittenberg. o.thomusch@gmx.de
OBJECTIVE:

To evaluate the preconditions that would justify total thyroidectomy as part of the primary therapy concept for benign multinodular goiter.
MATERIAL AND METHODS:

The Quality Assurance Study of Benign and Malignant Goiter covering the period from 1 January to 31 December 1998 assessed 5195 patients treated for benign goiter by primary bilateral resection. With respect to the extent of resection three groups were analyzed: bilateral subtotal resection (ST+ST, n=4580), subtotal resection with contralateral lobectomy (ST+HT, n=527), and total thyroidectomy (TT, n=88).

 RESULTS:

The postoperative morbidity increased with the extent of resection. The rate of permanent recurrent laryngeal nerve (RLN) palsy was 0.8% for ST+ST, 1.4% for ST+HT, and 2.3% for TT and of permanent hypoparathyroidism 1.5% for ST+ST, 2.8% for ST+HT, and 12.5% for TT. Multivariate analysis showed that the extent of resection significantly increased the risk of RLN palsy (transient RR 0.5, permanent RR 0.4) and hypoparathyroidism (transient RR 0.2,permanent RR 0.08). The surgeon's experience (RR 0.6) and identification of the RLN (RR 0.5) reduced the risk of permanent RLN palsy. Additionally, the development of permanent hypoparathyroidism was reduced if at least two parathyroid glands (RR 0.4) were identified. CONCLUSION: Total thyroidectomy is associated with an increased rate of RLN palsies and hypoparathyroidism in comparison to less extensive thyroid surgery. Due to the increased postoperative morbidity after total thyroidectomy, subtotal thyroid resection based on the morphologic changes in the thyroid gland is still recommended as the standard treatment regimen for multinodular goiter.

Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports. Pappalardo G, Guadalaxara A, Frattaroli FM, Illomei G, Falaschi P., 1998 Jul;164(7):501-6. 2nd Surgical Clinic--Policlinico Umberto I, University of Rome, La Sapienza, Italy. OBJECTIVE: To evaluate the outcome after total and subtotal thyroidectomy for the treatment of single and multinodular goitres in two comparable groups of patients. DESIGN: Prospective randomised study. SUBJECTS: 141 Patients operated on for benign goitre from 1975-85. INTERVENTIONS: 69 Patients were randomised to have total thyroidectomy and 72 subtotal thyroidectomy by standard techniques.

 MAIN OUTCOME MEASURES:

Temporary or permanent palsy of the recurrent laryngeal nerve, temporary or permanent hypoparathyroidism, recurrence of the goitre.

RESULTS: Patients were followed up for a median of 14.5 years (range 10-21). After total thyroidectomy 2 patients (3%) developed temporary palsy of the recurrent laryngeal nerve but there were no permanent lesions; and 24 (35%) developed temporary and 2 (3%) permanent hypoparathyroidism. After subtotal thyroidectomy 2 (3%) developed temporary and 1 (1%) permanent palsy of the recurrent laryngeal nerve; and 13 (18%) developed temporary and 1 (1%) permanent hypoparathyroidism. In addition, there were 10 recurrent goitres (14%).
CONCLUSION : Total thyroidectomy is the procedure of choice for the

treatment of benign nodular goitres.

Subtotal and near total versus total thyroidectomy for the management of multinodular goiter. Vaiman M, Nagibin A, Hagag P, Buyankin A, Olevson J, Shlamkovich N. 2008 Jul;32(7):1546-51 World J Surg. Department of Otorhinolaryngology Head and Neck Surgery, Assaf HaRofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel. vaimed@yahoo.
OBJECTIVE To compare rates of postsurgical complications following thyroidectomy for multinodular goiter through a retrospective multicenter cohort study. METHODS: All cases of thyroidectomy (total-TT; near total-NT; and bilateral subtotal-ST) performed in two hospitals from 1990 to 2005 were studied to determine the

incidence of complications after each procedure. Follow-up checked injury of laryngeal nerves, hypoparathyroidism, hypothyroidism, pathology recurrence, and appearance of neoplasm.

 RESULTS:

There were 6,223 cases: TT, n = 3,834 (61.6%); ST, n = 2,238 (36%); and NT, n = 151 (2.4%) NT). Of this total, 2,758 (44.3%) patients were men and 3,465 (55.7%) were women with a mean age of 48.7. Postoperative mean follow-up was 7 years, 2 months. Permanent recurrent laryngeal nerve (RLN) injury was observed in 1.4% in the TT group, 1.2% in the ST group, and 1.1% in the NT group (p > 0.1). Permanent hypocalcemia was observed in 2% in TT group, 1.9% in the ST group, and 2% in the NT group (p > 0.1). Permanent hypothyroidism occurred in all patients in the TT and NT groups, compared to 91% of the patients in the ST group (p > 0.1). Recurrence of benign disease was noted in 491 patients (20.5% of ST and NT cases combined; p < 0.05), n = 482 (21.5%) after ST and n = 9 (5.9%) after NT. Of the patients with recurrence, 173 needed a completion thyroidectomy. Malignant transformation was observed in 28 cases. CONCLUSIONS: There is no statistically significant difference in complications among TT, NT, and ST groups. Partial thyroidectomies provide no decisive advantage over total thyroidectomies in terms of subsequent requirements of supplemental hormone therapy.