ORIGINAL ARTICLE Changes in the choice of thyroidectomy for benign thyroid disease Bulent Citgez • Mehmet Uludag • Gurkan Yetkin • Faruk Yener • Ismail Akgun • Adnan Isgor Received: 24 November 2011 / Accepted: 16 March 2012 Ó Springer 2012 Abstract Purposes There is an increasing trend towards perform- ing more radical resections instead of a subtotal resection for benign thyroid disease. The aim of this study was to examine the effect of this change in practice on the surgical treatment of bilateral thyroid diseases in this unit. Methods The data on 367 patients that underwent a bilateral thyroidectomy were categorized by dividing the operation types into 4 groups: (1) total thyroidectomy (TT), (2) near-total thyroidectomy, (3) Dunhill procedure, and (4) bilateral subtotal thyroidectomy. Results A statistically significant change in the choice of thyroidectomy occured during the study period (p \ 0.001). TT has replaced subtotal thyroidectomy (STT; bilateral subtotal thyroidectomy and Dunhill procedure) as the preferred routine surgical procedure for bilateral benign thyroid diseases in this clinic. The permanent complication rates were similar for all surgical procedures. The rate of secondary thyroidectomy for both recurrence of multino- dular goiter and incidental thyroid carcinoma were signif- icantly higher in the STT groups, than the total in the TT and near-total thyroidectomy patients. Conclusions Total or near total thyroidectomy procedures are now being increasingly employed to treat bilateral benign thyroid disease, and are as safe as the sub-total thyroidectomy procedures, which are more conservative and associated with significantly higher recurrence rates. Keywords Total thyroidectomy Á Subtotal thyroidectomy Á Permanent complications Á Recurrence Á Incidental thyroid carcinoma Introduction Many areas of surgery continually try to balance the benefits of extensive resection in terms of palliation and cure and the increased potential for complications asso- ciated with more radical procedures. Total thyroidectomy (TT) is such a procedure and is one of the most frequent operations performed, especially in iodine-deficient regions [1]. Endemic goiter and iodine deficiency is an important public health problem, particularly in some areas of Turkey, as well as in many areas throughout the world [2]. There is still debate over the extent of resection for benign and malignant thyroid pathologies more than 100 years after Theodor Kocher’s first safe thyroidectomy [3, 4]. However, TT was only occasionally performed for indications other than cancer until the last quarter of the Twentieth century. Surgeons have been performing TT with increasing prevalence in comparison to other types of thyroid operations for benign thyroid disease. TT and near- total thyroidectomy (NTT) have replaced subtotal thy- roidectomy (STT) as the surgical procedure of choice even for the treatment of benign thyroid disease affecting both lobes of the thyroid, with good results [1, 5, 6]. This policy change was in response to the apparent increasing inci- dence of secondary thyroid surgery for recurrent goiter and resulted in a significantly higher rate of completion thy- roidectomy for incidentally diagnosed thyroid carcinoma in patients that had previously undergone STT for benign thyroid disease [5, 7]. B. Citgez (&) Á M. Uludag Á G. Yetkin Á F. Yener Á I. Akgun Department of General Surgery, Sisli Etfal Training and Research Hospital, Istanbul, Turkey e-mail: bcitgez@yahoo.com A. Isgor Golden Horn University Health Sciences Institute, Aksaray, Istanbul, Turkey 123 Surg Today DOI 10.1007/s00595-012-0297-3