Indications for Surgical Management of Adenomatous Goiter; Analysis of 91 Surgical Cases.

The management of adenomatous goiter (AG), a disease for which there are various treatment strategies, continues to generate significant controversy. A number of papers have recommended surgical management as a result of the relatively high incidence of combined malignancy reported in patients with this disorder. However, we are reluctant to perform thyroidectomy as the first therapy for this hyperplastic thyroid disease. The overall incidence of thyroidectomy with a postoperative histology indicating as AG, was 8.7% (91 patients) out of 1048 patients being operated on for various thyroid diseases in our department over the last 16 years (1981-1996). However, the number of patients with a correct preoperative diagnosis of AG was 41(3.9%). These 41 patients were categorized as having essential indications for surgical management of AG. Furthermore, the incidence of combined malignancy in the 91 patients who underwent thyroidectomy was as low as 3% (3 patients, all T1N0). On the contrary, the incidence of AG in patients operated on for various thyroid malignancies was 9%. This rate was lower than those reported previuosly, which suggests that efforts directed at a more punctual preopeartive diagnosis, were reasonable. Hence, our first strategy is to treat patients suffering from AG with TSH suppression therapy and repeated ultrasonic echography (with or without fine needle aspiration cytology). This strategy appears to be a reasonable approach in cases of AG.