166 https://www.id-press.eu/mjms/index Scientifc Foundation SPIROSKI, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2020 Apr 25; 8(B):166-170. https://doi.org/10.3889/oamjms.2020.3929 eISSN: 1857-9655 Category: B - Clinical Sciences Section: Surgery Evaluation of Total Thyroidectomy for Treatment of Benign Diseases of Thyroid Gland Risto Cholancheski¹*, Natasha Tolevska¹, Ardit Qafjani¹, Ilir Vela¹, Borislav Kondov¹, Goran Kondov¹, Nexhati Jakupi¹, Igor Dzikovski¹, Anita Kokareva², Mimi Srceva², Marija Tolevska², Andrijan Kartalov², Zoran Arsovski³, Andjela Vitanova 1 , Nina Apostolovska¹ ¹Department of Thoracic Surgery, University Clinic for Thoracic and Vascular Surgery, Medical Faculty Skopje, Republic of Macedonia, Balkans; ²Department of  Anestesiology, University Clinic for TOARILUC-KARIL, Medical Faculty Skopje, Republic of Macedonia, Balkans; ³Department of  Pulmology, University Clinic for Pulmonology and Allergology, Medical Faculty Skopje, Republic of Macedonia, Balkans Introduction The risks of surgical complications from total thyroidectomy (TT) have deterred surgeons to practice it for more than a century ago when it was introduced as a major neck surgery [1], [2], [3]. It was the problem of hormonal replacement which was the main obstacle for doing the TT. With the rise of technical and technological possibilities of surgery at the end of 20 th century, the question of doing TT arises from the need of adequate treatment if thyroid carcinoma only at the beginning of the 21 st century the question of TT for benign disease arose to the level of controversy whether is it safe and complication free, along with the development of thyroid hormone substitute thyroxin and surgical technology for safer operative techniques [4]. Furthermore, the development of more accurate diagnostic possibilities as US m CT, US-guided FNAB and biochemical laboratories, and radioactive scans of thyroid gland, made better accuracy of different diagnosis strict and exact differentiation of benign and malignant pathology of the thyroid gland. Although the quantity of resected thyroid gland for benign disease is still controversial, increasing number of surgeons is prone to TT for benign disease such as multinodular euthyroid goiter (MNEG), multimodal toxic goiter (MNTG), Graves’s Abstract BACKGROUND: The controversy of using total thyroidectomy (TT) in treatment of benign thyroid diseases still remains controversial over the rates of complication, mostly recurrence nerve palsy and hypocalcemia, compared to non-total thyroidectomies. The latest reports in this feld of research showed that that the number of complications of TT is decreasing as the skills of surgeons increase. AIM: In this study, we reviewed 209 cases of total thyroidectomies for benign thyroid diseases where such surgery was indicated. The results were evaluated whether they support the previous reports that TT is save method of treatment of diffuse multinodular goiters, Graves’ disease thyroid adenomas with diffuse goiters and thyroiditis. METHODS: Two hundred and nine patients, 36 males and 173 females, medium age 47 (17–77) operated with TT between 2016 and 2018 were included in the evaluation study. We evaluated the: Diagnosis, indications for operation, pre-operative medication administration, laryngeal recurrent nerve palsy, hypocalcemia, hypoparathyroidism, and patohistology fndings. The follow-up for hypocalcemia and laryngeal nerve palsy was performed 1 year postoperatively. RESULTS: The age of the patients was between 17 and 77 years, medium-range 47 years old. Of 209 patients, 173 (83%) were female and 36 (17%) male with a gender ratio of 1:4.8 males to females. Diagnoses before surgery were established as follows: Multinodular euthyroid goiter (MNEG) n = 106 (48.80%), multinodular toxic goiter n = 12 (5.74%), Graves’s disease n = 6 (2.87%), adenoma with multinodular goiter n = 73 (34.92%), and n = 16 (7.65%) patients with thyroiditis. Recurrence laryngeal nerve palsy (RLNP) occurred in 6 patients (2.87%), temporary within 3 months after the operation in 4 patients (1.92%) and permanent palsy within 6 months and more after an operation in 2 patients (0.95%). Voice hoarseness immediately and within 1 month after the operation was registered in 32 patients (15.3%). RLNP and hoarseness were registered mostly in patients with pre-operative problems, mostly with extra big MNEG. One of the permanent injuries of RLN was bilateral and all others were one sided. All patients were operated with normal pre-operative vocal cord movement fndings. Post-operative hypocalcemia was registered in 35 patients (16.74%). Temporary nonsignifcant hypocalcemia in 10 (4.78%), temporary signifcant hypocalcemia in 17 (8.13%), temporary severe hypocalcemia in 6 patients (2.87%), and permanent hypocalcemia in 2 patients (0.95%). CONCLUSION: Many studies have shown that the rate of complications is almost even for TT and NTT done for benign and malignant diseases of thyroid gland. Our data have shown that the risk of post-operative complications with TT is proportional to the number of complicated pre-operative fndings of benign thyroid glands. Edited by: Sasho Stoleski Citation: Cholancheski R, Tolevska N, Qafjani A, Vela I, Kondov B, Kondov G, Jakupi N, Dzikovski I, Kokareva A, Srceva M, Tolevska M, Kartalov A, Arsovski Z, Vitanova A, Apostolovska N. Evaluation of Total Thyroidectomy for Treatment of Benign Diseases of Thyroid Gland. Open Access Maced J Med Sci. 2020 Apr 25; 8(B):166-170. https://doi.org/10.3889/oamjms.2020.3929 Keywords: Total thyroidectomy; Hypocalcemia; Recurrence nerve *Correspondence: Risto Cholancheski, University Clinic for Thoracic and Vascular Surgery, Medical Faculty Skopje, University of “St. Cyril and Methodius” Skopje, Mother Theresa Str. 1000, Skopje, Republic of Macedonia. Tel.: +389-70-220-456. E-mail: colanceski@hotmail.com Received: 18-Oct-2019 Revised: 20-Dec-2019 Accepted: 20-Feb-2020 Copyright: © 2020 Risto Cholancheski, Natasha Tolevska, Ardit Qafjani, Ilir Vela, Borislav Kondov, Goran Kondov, Nexhati Jakupi, Igor Dzikovski, Anita Kokareva, Mimi Srceva, Marija Tolevska, Andrijan Kartalov, Zoran Arsovski, Andjela Vitanova, Nina Apostolovska Funding: This research did not receive any fnancial support Competing Interests: The authors have declared that no competing interests exist Open Access: This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial 4.0 International License (CC BY-NC 4.0)