ORIGINAL ARTICLE
Open Access

Outcomes of Total Versus Subtotal Thyroidectomy in Multinodular Goiter

Nimal J. Perera1, Harsha P. Siriwardana ORCID 2

1Department of General and Endocrine Surgery, Teaching Hospital Colombo, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
2Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
DOI: 10.18081/ajbm.2025.4.366

Publication History: Received 25 September 2025, Revised 23 October 2025, Accepted 14 November 2025, Available online 03 December 2025
Copyright: © 2025 Siriwardana, et al. This is an open-access article under a Creative Commons license (CC BY 4.0).
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ABSTRACT

Background

Multinodular goiter remains a common endocrine disorder in South Asia, including Sri Lanka, despite longstanding iodine supplementation programs. Surgical management is often required for symptomatic disease; however, the optimal extent of thyroid resection—total thyroidectomy (TT) versus subtotal thyroidectomy (ST)—continues to be debated, particularly in resource-limited settings. This study aimed to compare postoperative outcomes, complication rates, and recurrence between TT and ST in patients undergoing surgery for multinodular goiter.

Methods

A prospective comparative study was conducted at a tertiary referral center in Sri Lanka between 2019 and 2024. A total of 240 adult patients with bilateral multinodular goiter were included and underwent either total thyroidectomy (n = 120) or subtotal thyroidectomy (n = 120). Preoperative evaluation included thyroid function tests, ultrasonography, and fine-needle aspiration cytology when indicated. Primary outcomes were postoperative hypocalcemia and recurrent laryngeal nerve (RLN) injury. Secondary outcomes included operative time, hospital stay, incidental malignancy, recurrence, and need for reoperation. Statistical analysis was performed using standard comparative tests, with P < 0.05 considered significant.

Results

Total thyroidectomy was associated with a significantly longer operative time (P < 0.001) and a higher incidence of transient hypocalcemia (23.3% vs 10.0%; P = 0.006). However, rates of permanent hypocalcemia (2.5% vs 0.8%) and permanent RLN palsy (0.8% vs 0.8%) were low and comparable between groups. No recurrence was observed following total thyroidectomy, whereas 9.2% of patients in the subtotal thyroidectomy group developed recurrent nodular disease requiring medical treatment or reoperation (P < 0.001). Incidental thyroid carcinoma was detected more frequently in the TT group, allowing definitive management at the initial operation.

Conclusion

Total thyroidectomy provides superior long-term disease control compared with subtotal thyroidectomy for multinodular goiter, without increasing permanent complication rates when performed by experienced surgeons. Although transient hypocalcemia is more common after total thyroidectomy, it is manageable with standardized postoperative care. These findings support total thyroidectomy as the preferred surgical approach for bilateral multinodular goiter in Sri Lanka and similar South Asian settings, with implications for surgical training, guideline development, and health policy.

Keywords: Multinodular goiter; Total thyroidectomy; Subtotal thyroidectomy; Hypocalcemia; Recurrence

Recommended Citation

Perera NJ, Siriwardana HP. Serum Hepcidin Levels as Predictors of Transfusion Outcomes of Total Versus Subtotal Thyroidectomy in Multinodular Goiter. Advanced Journal of Biomedicine & Medicine. 2025;13(4):366-382. doi:10.18081/ajbm.2025.4.366

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Nimal J. Perera, Harsha P. Siriwardana (2025). Outcomes of Total Versus Subtotal Thyroidectomy in Multinodular Goiter<br /> . Advanced Journal of Biomedicine & Medicine, 13(4), 366-382. https://doi.org/10.18081/ajbm.2025.4.366
Nimal J. Perera, Harsha P. Siriwardana. "Outcomes of Total Versus Subtotal Thyroidectomy in Multinodular Goiter<br /> ." Advanced Journal of Biomedicine & Medicine, vol. 13, no. 4, 2025, pp. 366-382. DOI: 10.18081/ajbm.2025.4.366.
Nimal J. Perera, Harsha P. Siriwardana. Outcomes of Total Versus Subtotal Thyroidectomy in Multinodular Goiter<br /> . AJBM. 2025;13(4):366-382. DOI: 10.18081/ajbm.2025.4.366. PMID: .
Nimal J. Perera, Harsha P. Siriwardana 2025, "Outcomes of Total Versus Subtotal Thyroidectomy in Multinodular Goiter<br /> ", Advanced Journal of Biomedicine & Medicine, vol. 13, no. 4, pp. 366-382.
@article{nimal2025, title={Outcomes of Total Versus Subtotal Thyroidectomy in Multinodular Goiter<br /> }, author={Nimal J. Perera, Harsha P. Siriwardana}, journal={Advanced Journal of Biomedicine & Medicine}, volume={13}, number={4}, pages={366-382}, year={2025}, doi={10.18081/ajbm.2025.4.366} }
TY - JOUR AU - Nimal J. Perera, Harsha P. Siriwardana TI - Outcomes of Total Versus Subtotal Thyroidectomy in Multinodular Goiter<br /> JO - American Journal of Biomedicine VL - 13 IS - 4 SP - 366-382 PY - 2025 DO - 10.18081/ajbm.2025.4.366 ER -
%0 Journal Article %A Nimal J. Perera, Harsha P. Siriwardana %T Outcomes of Total Versus Subtotal Thyroidectomy in Multinodular Goiter<br /> %J American Journal of Biomedicine %V 13 %N 4 %P 366-382 %D 2025 %R 10.18081/ajbm.2025.4.366 %M
Nimal J. Perera, Harsha P. Siriwardana (2025). Outcomes of Total Versus Subtotal Thyroidectomy in Multinodular Goiter<br /> . Advanced Journal of Biomedicine & Medicine, 13(4), 366-382. https://doi.org/10.18081/ajbm.2025.4.366

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