Total Thyroidectomy versus Bilateral Subtotal Thyroidectomy for Bilateral Multinodular Nontoxic Goiter: A Meta-Analysis

Aim: The aim of this meta-analysis is to assess and validate the feasibility and safety of total thyroidectomy (TT) when compared to bilateral subtotal thyroidectomy (BST) for bilateral multinodular nontoxic goiter (BMNG). Materials and Methods: PubMed, Web of Knowledge, and Ovid's database were searched for studies published in English language between January 1990 and December 2014. A meta-analysis was performed to compare the complications and recurrences of TT versus BST. The search terms used were `total thyroidectomy', `bilateral subtotal thyroidectomy', `multinodular nontoxic goiter' and `randomized clinical trial'. The reference lists of relevant studies were checked manually to locate any missing studies. Results: Four trials with a total of 1,078 patients were analyzed. Although the incidence of transient hypoparathyroidism was higher in TT than in BST (OR = 2.59, 95% CI [1.58-4.24], p = 0.0002), TT was associated with a significantly lower incidence of recurrence (OR = 0.04, 95% CI [0.01, 0.17], p < 0.0001). There were no statistically significant differences for the presence of transient/permanent recurrent laryngeal nerve palsy and permanent hypoparathyroidism between the two groups. Conclusion: TT is a feasible and safe procedure for patients with BMNG. Although TT involves a significantly higher risk of postoperative transient hypoparathyroidism, it has a lower recurrence rate than BST. (C) 2016 S. Karger AG, Basel