Multinodular goiter: how is it dealt with in the Scorrano Surgery Department?

It means an increase in the volume of the thyroid which can be diffuse or nodular in turn of the uni nodular or multinodular type.

Characteristics and incidence

In addition to the genetic causes, the subjects most affected are those who have a diet low in iodine, an element found in salt and in the diet (fish) and in the ambient air.

The continuous stimulation of TSH (pituitary hormone) on the thyroid gland is the body’s attempt to compensate for the function of the thyroid gland by increasing its volume in a nodular or more or less diffuse way with the aim of increasing the thyroid uptake of iodine.

What are the symptoms

The symptoms are attributable to the deviation and compression of the goiter on adjacent structures such as the trachea and esophagus, especially in intrathoracic goiters. In fact, there may be difficulty in swallowing, coughing, hoarseness and, in malignant forms of goiter, even alteration of the voice. They also exist in hyperfunctioning goiters with symptoms related to hyperthyroidism : tachycardia, emotional lability, palpitations, profuse sweats. To these manifestations of hyperfunction an ocular pathology (exophthalmos) is added in the disease of Basedow which is an autoimmune pathology. To these manifestations we must always add the aesthetic problems due to swelling evident in the anterior region of the neck.

In patients with hyperfunctioning goiter, however, the symptoms are also linked to the hyperfunctionality of the thyroid.

Multinodular goiter: how is it dealt with in the Scorrano Surgery Department?

There is a close collaboration between our team and the group of endocrinologists who operate in the area. The thyroid pathology is followed in the first instance by the endocrinologists of the districts, is treated according to their indications with medical therapy until the endocrinologist himself decides to consult the surgeon for:

  1. Compression symptoms;
  2. Disease progression despite medical therapy due to volume increase;
  3. Positive needle aspiration for suspicious nodules.

In the General and Oncological Surgery Department of the Scorrano Hospital, the intervention that is performed is in most cases of total thyroidectomy.

Are there any risks?

The risks are related to the failure to comply with the parathyroid glands, small glands that are responsible for the balance of the calcium ion in the body with the secretion of the parathyroid hormone. The other problem of thyroidectomy is respect for the recurrent nerves, responsible for the innervation of the vocal cords. Their injury or the need for section leads to altered voice problems and in cases of bilaterality also to respiratory problems. Fortunately, in our case history we have not had cases of recurrent nerve injury and signs of permanent hyperparathyroidism even if such complications are contemplated in the literature.

To eliminate the risk of injuring the recurrent nerves and for medico-legal problems, for some time at the UOC of General Surgery of Scorrano we have been using an NIM (Nerve Intraoperative Monitoring) technique for intraoperative monitoring of the recurrent nerves in order to have, during the intervention the exact detection of nerve function and, thus avoiding any injury in the event of nerve course anomalies.


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