World Journal of Endocrine Surgery

Register      Login

VOLUME 11 , ISSUE 1 ( January–April, 2019 ) > List of Articles


Recurrent Goiters

R Fernando

Keywords : Recurrent goiter, Thyroid surgery, Total thyroidectomy

Citation Information : Fernando R. Recurrent Goiters. World J Endoc Surg 2019; 11 (1):15-18.

DOI: 10.5005/jp-journals-10002-1247

License: CC BY-NC 4.0

Published Online: 01-12-2018

Copyright Statement:  Copyright © 2019; The Author(s).


A recurrent goiter is the regrowth of thyroid tissue after thyroidectomy. The causes of recurrence following surgery for the benign disease can be broadly attributed to inadequate surgery, embryological remnants left behind inadvertently, and the development of a malignancy in the remnant. Recurrence after surgery for the benign disease should be preventable. Subtotal thyroidectomy (STT) was the main operation for goiters until the 1980s. The main issue with a subtotal surgery is a recurrence. One of the primary reasons why STT fails can be attributed to the fact that STT does not treat the underlying generalized disease adequately. The consensus is emerging that the best surgical option for multinodular goiter is total thyroidectomy. Even after “total” thyroidectomy, there is recurrence, what is left behind is related to the three embryological remnants of thyroid, namely pyramidal lobe recurrences, recurrence of the tubercle of Zuckerkandl, and thyrothymic recurrences. The surgical technique at the initial total thyroidectomy must be meticulous, ensuring that all embryological remnants are excised properly. Goiter recurrence is a failure of surgical treatment of goiter. Inadequate surgery and failure to excise all thyroid tissues are two preventable causes for recurrence. The technique of reoperative thyroidectomy must include capsular dissection, removal of all embryological remnants, and parathyroid autotransplantation. Surgery for recurrent goiter is challenging. It is thought to entail a higher complication rate and complication rates may be high in inexperienced hands; low complication rates have been achieved in specialized centers. The fear of complications should not deter experienced surgeons from performing reoperative thyroid surgery. In terms of technique, the lateral approach to thyroid offers a good alternative for recurrent goiters. A meticulous technique and parathyroid autotransplantation will help minimize the complication rate.

  1. Moalem J, Suh I, et al. Treatment and prevention of recurrence of multinodular goiter: an evidence-based review of the literature. World J Surg July 2008:32(7):1301–1312. DOI: 10.1007/s00268-008- 9477-0.
  2. Ignjatovic M. Overview of the history of thyroid surgery. Acta Chir Iugosl 2003;50:9–36.
  3. Sarkar S, Banerjee S, et al. A review on the history of ‘thyroid surgery’. Indian J Surg 2016 Feb;78(1):32–36. DOI: 10.1007/s12262-015-1317-5.
  4. Yoldas T, Makay O, et al. Should subtotal thyroidectomy be abandoned in multinodular goiter patients from endemic regions requiring surgery? Int Surg 2015 Jan;100(1):9–14. DOI: 10.9738/ INTSURG-D-13-00275.1.
  5. Röjdmark J, Järhult J. High long term recurrence rate after subtotal thyroidectomy for nodular goitre. Eur J Surg 1995 Oct;161(10): 725–727.
  6. Pappalardo G, Guadalaxara A, et al. Total compared with subtotal thyroidectomy in benign nodular disease: personal series and review of published reports. Eur J Surg 1998 Jul;164(7):501–506. DOI: 10.1080/110241598750005840.
  7. Cappellani A, Di Vita M, et al. Ann Ital Chir 2008;79:247–254.
  8. Cirocchi R, Trastulli S, et al. Cochrane Database Syst Rev 2015 Aug 7: CD010370. DOI: 10.1002/14651858.CD010370.pub2.
  9. Medeiros-Neto G, Multinodular goiter in thyroid disease manager is produced and edited Leslie J De Groot. Last updated: September 26, 2016.
  10. Derwahl M, Studer H. Multinodular goitre: ‘much more to it than simply iodine deficiency’. Baillieres Best Pract Res Clin Endocrinol Metab 2000 Dec;14(4):577–600. DOI: 10.1053/beem.2000.0104.
  11. Peter HJ, Gerber H, et al. Pathogenesis of heterogeneity in human multinodular goiter. A study on growth and function of thyroid tissue transplanted onto nude mice. J Clin Invest 1985 Nov;76(5):1992–2002. DOI: 10.1172/JCI112199.
  12. Kulacoglu H, Dener C, et al. Thyroxine prophylaxis after bilateral subtotal thyroidectomy for multinodular goiter. Endocr J 2000; 47(3):349–352.
  13. Perzik SL. The place of total thyroidectomy in the management of 909 patients with thyroid disease. Am J Surg 1976 Oct;132(4):480–483.
  14. Reeve TS, Delbridge L, et al. Total thyroidectomy. The preferred option for multinodular goiter. Ann Surg 1987 Dec;206(6):782–786.
  15. Peix JL, Van Box Som P. Role of total thyroidectomy in the treatment of benign thyroid diseases. Ann Endocrinol 1996;57(6):502–507.
  16. Liu Q, Djuricin G, et al. Total thyroidectomy for benign thyroid disease. Surgery 1998 Jan;123(1):2–7.
  17. Malcolm H. Wheeler total thyroidectomy for benign thyroid disease. Lancet, 23 May 1998;351:1526–1527. DOI: 10.1016/S0140- 6736(05)61116-6.
  18. Tezelman S, Borucu I, et al. The change in surgical practice from subtotal to near-total or total thyroidectomy in the treatment of patients with benign multinodular goiter. World J Surg 2009;33(3):400–405. DOI: 10.1007/s00268-008-9808-1.
  19. Snook KL, Stalberg PLH, et al. Recurrence after total thyroidectomy for benign multinodular goiter. World J Surg March 2007;31(3):593–598. DOI: 10.1007/s00268-006-0135-0.
  20. Cirocchi R, Trastulli S, et al. Total or near-total thyroidectomy versus subtotal thyroidectomy for multinodular non-toxic goitre in adults. Cochrane Database Syst Rev 2015
  21. Zeuren R, Biagini A, et al. RAI thyroid bed uptake after total thyroidectomy: a novel SPECT-CT anatomic classification system. Laryngoscope 2015 Oct;125(10):2417–2424. DOI: 10.1002/lary.25295.
  22. Hisham AN, Aina EN. Zuckerkandl tubercle of the thyroid gland in association with pressure symptoms: a coincidence or consequence? Aust N Z J Surg 2000 Apr;70(4):251.
  23. Yun JS, Lee YS, et al. The Zuckerkandl tubercle: a useful anatomical landmark for detecting both the recurrent laryngeal nerve and the superior parathyroid during thyroid surgery. Endocr J 2008 Oct;55(5):925–930.
  24. Sackett WR, Reeve TS, et al. Thyrothymic thyroid rests: incidence and relationship to the thyroid gland. J Am Coll Surg 2002 Nov;195(5): 635–640.
  25. Dissanayake DDMC, Fernando RF. Lateral approach to the thyroid: a good technique for reoperative thyroid surgery. World J Endocr Surg May-August 2016;8(2):1–2.
  26. Levin KE, Clark AH, et al. Reoperative thyroid surgery. Surgery 1992; 111(6):604–609.
  27. Rudolph N, Dominguez C, et al. The morbidity of reoperative surgery for recurrent benign nodular goitre: impact of previous unilateral thyroid lobectomy versus subtotal thyroidectomy. J Thyroid Res 2014;2014:1–46.
  28. Malik R, Linos D. Intraoperative neuromonitoring in thyroid surgery: a systematic review. World J Surg Aug 2016;40(8):2051–2058. DOI: 10.1007/s00268-016-3594-y.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.