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Recurrence rates of benign nodular goiter after total thyroidectomy were essentially nonexistent (range = 0\u20130.3%) compared with those after subtotal thyroidectomy (range = 2.5\u201342%) and more limited resections (range = 8\u201334%). There was no difference between total and less\u2010than\u2010total thyroidectomy with respect to temporary recurrent laryngeal nerve (RLN) injury (1\u201310% vs. 0.9\u20136%, respectively) or permanent RLN palsy (0\u20131.4%). There was, however, a significantly higher rate of transient hypocalcemia after total thyroidectomy than less extensive operations (9\u201335% vs. 0\u201318%, respectively). In relation to redo surgery, permanent hypoparathyroidism appeared to be far more common in the redo group (0\u201322% vs. 0\u20134%) Moreover; the redo group had more frequent RLN injury, both temporary (0\u201322% vs. 0.5\u201318%) and permanent (0\u201313% vs. 0\u20134%). About half the studies examined conclude that postoperative TSH suppression is effective in reducing recurrences, while the other half state that it is not.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The definitive management and prevention of recurrence of benign nodular goiter is primarily surgical. Total thyroidectomy essentially eliminates the risk of recurrence without an accompanying increased risk of permanent hypoparathyroidism or RLN injury. Therefore, total thyroidectomy should be considered the procedure of choice for benign multinodular goiter whenever possible, especially considering that reoperations for goiter are significantly more morbid than any initial operation.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-008-9477-0","type":"journal-article","created":{"date-parts":[[2008,2,29]],"date-time":"2008-02-29T16:20:08Z","timestamp":1204302008000},"page":"1301-1312","source":"Crossref","is-referenced-by-count":104,"title":["Treatment and Prevention of Recurrence of Multinodular Goiter: An Evidence\u2010based Review of the Literature"],"prefix":"10.1002","volume":"32","author":[{"given":"Jacob","family":"Moalem","sequence":"first","affiliation":[{"name":"Endocrine Surgery University of California 94143 San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Insoo","family":"Suh","sequence":"additional","affiliation":[{"name":"Endocrine Surgery University of California 94143 San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Quan\u2010Yang","family":"Duh","sequence":"additional","affiliation":[{"name":"Endocrine Surgery University of California 94143 San Francisco CA USA"},{"name":"Surgical Service Veteran Affairs Medical Center 4150 Clement Street 94121 San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2008,2,28]]},"reference":[{"key":"e_1_2_7_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01659054"},{"key":"e_1_2_7_3_2","doi-asserted-by":"publisher","DOI":"10.1080\/11024150152717634"},{"key":"e_1_2_7_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102265.1977.tb01340.x"},{"key":"e_1_2_7_5_2","doi-asserted-by":"publisher","DOI":"10.1148\/radiology.181.3.1947082"},{"key":"e_1_2_7_6_2","doi-asserted-by":"publisher","DOI":"10.1210\/jcem\u201015\u201010\u20101270"},{"key":"e_1_2_7_7_2","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.nu.03.070183.002013"},{"key":"e_1_2_7_8_2","doi-asserted-by":"publisher","DOI":"10.1067\/msy.2000.100937"},{"key":"e_1_2_7_9_2","first-page":"319","article-title":"Analysis and prevention of recurrent goiter","volume":"176","author":"Kraimps JL","year":"1993","journal-title":"Surg Gynecol Obstet"},{"key":"e_1_2_7_10_2","doi-asserted-by":"publisher","DOI":"10.1007\/s002689900092"},{"key":"e_1_2_7_11_2","first-page":"1097","article-title":"Prospective, randomized, double\u2010blind study about effectiveness of levothyroxine suppressive therapy in prevention of recurrence after operation: result at the third year of follow\u2010up","volume":"114","author":"Miccoli P","year":"1993","journal-title":"Surgery"},{"key":"e_1_2_7_12_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2006.0277"},{"key":"e_1_2_7_13_2","doi-asserted-by":"publisher","DOI":"10.4158\/EP.10.4.353"},{"key":"e_1_2_7_14_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2001\u2010011762"},{"key":"e_1_2_7_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.otohns.2005.06.007"},{"key":"e_1_2_7_16_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365\u20102265.2002.01650.x"},{"key":"e_1_2_7_17_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2002\u2010020365"},{"key":"e_1_2_7_18_2","doi-asserted-by":"publisher","DOI":"10.1080\/110241598750005840"},{"key":"e_1_2_7_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.surg.2004.06.054"},{"key":"e_1_2_7_20_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010004\u20107607\u2010x"},{"key":"e_1_2_7_21_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445\u20101433.2004.03139.x"},{"key":"e_1_2_7_22_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00423\u2010006\u20100091\u2010z"},{"key":"e_1_2_7_23_2","doi-asserted-by":"publisher","DOI":"10.1097\/00005537\u2010200310000\u201000030"},{"key":"e_1_2_7_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6060(98)70221-1"},{"key":"e_1_2_7_25_2","doi-asserted-by":"publisher","DOI":"10.1080\/110241502320789078"},{"key":"e_1_2_7_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010006\u20100135\u20100"},{"key":"e_1_2_7_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658\u2010199809000\u201000005"},{"key":"e_1_2_7_28_2","doi-asserted-by":"publisher","DOI":"10.1007\/s002680010221"},{"key":"e_1_2_7_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s002689900186"},{"key":"e_1_2_7_30_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.84.2.756"},{"key":"e_1_2_7_31_2","first-page":"715","article-title":"Effect of post\u2010operative thyroid hormone therapy on the recurrence of benign thyroid nodules. 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