Total vs less than total thyroidectomy for benign multinodular non-toxic goiter: an updated systematic review and meta-analysis

Background We have performed an updated meta-analysis of randomized controlled trials (RCT) comparing total thyroidectomy (TT) with less than total thyroidectomy (LTT) for benign multinodular non-toxic goiter (BMNG). Objectives The objective was to evaluate the effects and outcomes of TT as compared to LTT. Methods Eligibility criteria: RCTs comparing TT vs LTT. Information sources : PubMed, Embase, Cochrane Library and online registers were searched for articles comparing TT with LTT. Risk of bias : Articles were assessed for risk of bias using the Cochrane’s revised tool to assess risk of bias in randomized trials (RoB 2 tool). Synthesis of results : The main summary measures were risk difference using a random effects model. Results Five randomized controlled trials were included in the meta-analysis. Recurrence rate was lower for TT compared to LTT. Adverse events like temporary or permanent recurrent laryngeal nerve (RLN) palsy and permanent hypoparathyroidism were similar in both groups except for the rate of temporary hypoparathyroidism which was lower in the LTT group. Discussion All studies had unclear risk of bias for blinding of the participants and personnel and high risk of bias for certain selective reporting. This meta-analysis did not show any clear benefit or harm of either procedure (TT vs LTT) for goiter recurrence and re-operation rates (for both recurrence and incidental thyroid cancer). However, re-operation for goiter recurrence was significantly higher in the LTT group based on a single RCT. Evidence suggests increased rates of temporary hypoparathyroidism with TT but there was no difference in the rate of RLN palsy and permanent hypoparathyroidism between the two methods. The overall quality of evidence was low to moderate.