Abstract
Use of total thyroidectomy (TT) for differentiated thyroid carcinoma is controversial, but even more controversial is the use of TT for benign thyroid disease. The utility of TT for benign thyroid diseases aims at avoiding the risk of leaving behind abnormal thyroid tissue, a potential source of disease recurrence. Suppressive hormonal treatment with L-thyroxin after partial thyroid resection often does not prevent re-growth in the thyroid remnant. It is also well known that re-operation greatly increases the risk of injury to the parathyroid glands and recurrent laryngeal nerves. TT is considered extremely effective in patients with Grave's disease with progressive exophthalmos. However, for most surgeons, benign thyroid disease does not represent an indication for TT. Most surgeons prefer to perform subtotal thyroidectomy for such benign condition as multinodular goiter and hyperthyroidism even when they have to leave grossly abnormal tissue in the neck owing to the complication rate associated with this procedure. With the emergence of surgical endocrinology as superspeciality, total thyroidectomy has been particularly relevant in endemic regions where patients present with a long standing large nodular goiter with virtually no normal thyroid tissue. Total thyroidectomy has therefore, been considered a valuable option for treating benign thyroid disorders.