A Reasonable Amount of Preserved Thyroid Tissue in Thyroidectomy for Multi-nodular Nodular Goiter

Objective: The Dunhill procedure gave us an idea to develop a more objective way to preserve thyroid remnant when performing subtotal lobectomy. We want to study whether a modified ”Dunhill procedure” can decrease the recurrence rate and not increase the complication rate when we perform the procedure for treatment of multiple nodular goiter. Methods: 269 patients took part in this study. 266 patients had bilateral multiple nodular goiter and 3 patients had bilateral multiple nodular goiter combined with a cyst. One hundred and thirty five (135) patients in group A were operated on with a modified ”Dunhill procedure”. One hundred and thirty four (134) patients in group B were operated on by bilateral subtotal thyroidectomy with 3-4gm of thyroid remnant on each side. Results: Recurrent nodular goiter occurred in 1 case in group A and 8 cases in group B. The difference was statistically significant (p=0.016) between the two groups. No recurrent laryngeal nerve injury occurred in group A or B intraoperatively. Transient cord palsy was found in 5 patients each in groups A and B. The incidence of temporary nerve palsy was identical (almost identical) in both groups. No patient needed calcium supplement 6 months after surgery. The numbers of patients who needed thyroxine during the follow-up period or still took thyroxine at the last follow up between the two groups were not significantly different. Conclusion: We conclude that our modified ”Dunhill procedure” could be a considerable method in the treatment of multiple nodular goiter from the viewpoint of a decreased recurrence and without increased hypothyroidism or other complications.