Although has become increasingly acceptable to perform total thyroidectomy for bilateral and multiple benign nodules, diffuse toxic goiter, and thyroid cancers, surgeons continue to debate whether the potential benefits outweigh the potential complications of this procedure. The aim of this study was to evaluate the safety, effectiveness and complications of total thyroidectomy for malignant and benign thyroid diseases.

The medical records from 332 patients who had undergone total thyroidectomy for malignant and benign diseases between January 1990 and December 1999 at St. Mary's Hospital and St. Vincent's Hospital were reviewed retrospectively.

Of the 332 patients, 121 had had benign disease and 211 had had carcinomas. Female patients were predominate, being 6.4 times the number of males. The incidence rate by age peaked in the 4th decade for patients. Masses of below 2 cm in diameter were the second most common size (30.8%) and 2 to 5 cm occupied more than half (51%). Of the 211 thyroid carcinomas, histologic types were papillary in 185 patients (87.7%), follicular in 21 (10%), anaplastic in 3 (1.5%), medullary in 1 (0.5%) and lymphoma in 1 (0.5%). Of the 121 benign disease, 71 (58.7%) were benign multiple nodular goiters, 23 (19%) toxic diffuse goiter, and there were 18 cases (14.9%) of Hashimoto thyroiditis and 9 (7.4%) of adenomatous goiter. Among the 211 patients who underwent total thyroidectomy for thyroid malignancy, anterior compartment lymph node dissection was performed in 53 patients (25.1%). Modified radical neck dissection was done in 31 cases, due to suspicions of local lymph node invasion during the operation. Radical neck dissection was done in 10 cases with palpable cervical nodes. The most common complication was early postoperative hypocalcemia 108 (32.5%), most of which was transient and sixty-three percent of which was symptomatic. It usually persisted less than 7 days, and the difference in incidence of post-operative hypocalcemia between benign disease and malignancy was not significant. The other complications were hoarseness (13%), bleeding (3%) and the recurrent laryngeal nerve injury (1.5%).

Total thyroidectomy can be performed without additional risk compared with subtotal thyroidectomy for bilateral benign and malignant thyroid diseases, if done meticulously.