Thyroidectomy for large multinodular colloid goitre.

Between 1983 and 1993 a total of 474 patients underwent thyroidectomy in one surgical unit. In 64 (14%) of these, a multinodular colloid goitre weighing more than 100 g was resected. Preoperative symptoms in this group of patients with large goitres included respiratory difficulty (42%) and dysphagia (22%) whilst 22% demonstrated distension of the veins of the neck or anterior chest wall. Plain radiography revealed evidence of tracheal deviation in 70% of patients and tracheal compression in 42%. Total thyroidectomy was carried out in 47 patients and unilateral total lobectomy in 11; six patients underwent completion thyroidectomy for massive recurrent goitre following previous resection. There was no perioperative mortality. Complications included permanent unilateral vocal cord paralysis in two patients (1.7% of recurrent laryngeal nerves at risk), permanent hypoparathyroidism in two (3.1%) and temporary emergency tracheostomy in one individual. We advocate total resection for patients with large multinodular colloid goitre.