A COMPARATIVE INSTITUTIONAL POSTOPERATIVE STUDY OF ELECTIVE TOTAL THYROIDECTOMY VERSUS HEMITHYROIDECTOMY FOR SOLITARY NODULAR GOITER IN LOW- AND MIDDLEINCOME GROUPS OF PATIENTS IN A TERTIARY CENTRE

Abstract

Background: Solitary nodular goiter (SNG) is a common endocrine disorder in low- and middle-income countries (LMICs). Surgical management remains the mainstay, with total thyroidectomy (TT) and hemithyroidectomy (HT) being the primary options. However, controversy persists regarding the optimal procedure, particularly in LMIC settings where recurrence, cost, and postoperative morbidity must be balanced.

Objective: This study compared postoperative outcomes of TT versus HT for SNG in LMIC patients treated in a tertiary care center.

Methods: A prospective observational study was conducted over 2 years, enrolling 92 patients with clinically and radiologically diagnosed SNG. Patients were equally divided into TT (n=46) and HT (n=46) groups. Postoperative complications, recurrence rates, and need for reoperation were assessed. Statistical analysis used chi-square and t-tests, with p<0.05 considered significant.

Results: Transient hypocalcemia was significantly higher in the TT group (30.4%) compared to the HT group (6.5%) (p=0.01). Recurrent laryngeal nerve (RLN) palsy occurred more frequently in TT (8.7%) than HT (2.2%), though not statistically significant (p=0.19). Recurrence within 12 months was significantly higher in HT (15.2%) compared to TT (2.2%) (p=0.04). No cases of permanent hypocalcemia or bilateral RLN palsy were reported.

Conclusion: TT offered superior recurrence prevention but carried a higher risk of transient hypocalcemia. HT demonstrated fewer immediate complications but had significantly higher recurrence rates necessitating completion surgery. In LMIC settings, careful patient selection is crucial to balance safety, long-term efficacy, and healthcare burden.