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Total vs less than total thyroidectomy for benign multinodular non-toxic goiter: an updated systematic review and meta-analysis

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Abstract

Background

We have performed an updated meta-analysis of randomized controlled trials (RCT) comparing total thyroidectomy (TT) with less than total thyroidectomy (LTT) for benign multinodular non-toxic goiter (BMNG).

Objectives

The objective was to evaluate the effects and outcomes of TT as compared to LTT.

Methods

Eligibility criteria: RCTs comparing TT vs LTT. Information sources: PubMed, Embase, Cochrane Library and online registers were searched for articles comparing TT with LTT. Risk of bias: Articles were assessed for risk of bias using the Cochrane’s revised tool to assess risk of bias in randomized trials (RoB 2 tool). Synthesis of results: The main summary measures were risk difference using a random effects model.

Results

Five randomized controlled trials were included in the meta-analysis. Recurrence rate was lower for TT compared to LTT. Adverse events like temporary or permanent recurrent laryngeal nerve (RLN) palsy and permanent hypoparathyroidism were similar in both groups except for the rate of temporary hypoparathyroidism which was lower in the LTT group.

Discussion

All studies had unclear risk of bias for blinding of the participants and personnel and high risk of bias for certain selective reporting. This meta-analysis did not show any clear benefit or harm of either procedure (TT vs LTT) for goiter recurrence and re-operation rates (for both recurrence and incidental thyroid cancer). However, re-operation for goiter recurrence was significantly higher in the LTT group based on a single RCT. Evidence suggests increased rates of temporary hypoparathyroidism with TT but there was no difference in the rate of RLN palsy and permanent hypoparathyroidism between the two methods. The overall quality of evidence was low to moderate.

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Authors and Affiliations

  1. Department of Surgery, NSCB Medical College, Jabalpur, India

    S. Bharath, Sanjay Kumar Yadav & Dhananjaya Sharma

  2. Netaji Subhash Chandra Bose Medical College, Jabalpur, India

    Sanjay Kumar Yadav

  3. Department of Surgery, AIIMS, Patna, India

    Chandan Kumar Jha

  4. Department of Endocrine Surgery, SGPGIMS, Lucknow, India

    Anjali Mishra

  5. Gangwal School of Medical Science and Technology, Indian Institute of Technology, Kanpur, India

    Saroj Kanta Mishra

  6. Department of PSM and Biostatistics, Rama Medical College, Kanpur, India

    Saket Shekhar

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Contributions

BS and SKY: literature search, figures, study design, data collection, data analysis, data interpretation, and writing. DS: conceived the present idea, planning, revision, and editing of the manuscript. SS and CKJ: data analysis and interpretation. AM and SKM: figures and editing. All authors: revision and editing.

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Correspondence to Sanjay Kumar Yadav.

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Bharath, S., Yadav, S.K., Sharma, D. et al. Total vs less than total thyroidectomy for benign multinodular non-toxic goiter: an updated systematic review and meta-analysis. Langenbecks Arch Surg 408, 200 (2023). https://doi.org/10.1007/s00423-023-02941-1

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