Institutional Patterns of Recurrent Goitre: A Retrospective Analysis of Thyroidectomy Outcomes from Two Nigerian Referral Centers

Abstract

Recurrent goitre remains a major surgical challenge in low-resource settings, where subtotal thyroidectomy is still practiced despite its high recurrence rates inherent. In this retrospective two-center study, 354 thyroidectomies performed from 2009 to 2021 in two Nigerian tertiary hospitals were reviewed to evaluate patterns, outcomes, and determinants of recurrence. Four patients with incomplete data were excluded, and 34 recurrent goitre patients were analyzed. Demographic data, previous surgical history, operative results, and histopathology were gleaned from institutional records and examined. The cohort had a notable female preponderance (85.3%, p<0.001). Fifty percent of patients were between 45–64 years old. Residents from rural areas made up 52.9% of cases, mirroring systemic healthcare access inequalities. A total of 88.2% of recurrences occurred after initial subtotal thyroidectomy (p<0.001), highlighting the inadequacy of this procedure. The recurrences ranged from 1 to 12 years. Clinical presentations were predominantly in the form of simple nodular goitre (61.8%), while 23.5% of pathologic specimens presented with unsuspected malignancies, which were predominantly papillary carcinoma. Reoperations were completion
thyroidectomy (35.3%) and repeat subtotal operations (29.4%), with an overall complication rate of 36.4%, comparable to other LMIC environments. Complications were most commonly hemorrhage (37.5% of complicated cases), followed by transient hypocalcaemia (25.0%) and recurrent laryngeal nerve damage (12.5%). Completion thyroidectomy patients experienced increased morbidity compared to primary surgery groups. Notably, 58.8% of index procedures had been performed by non-specialist surgeons, denoting training gaps. The findings highlight subtotal thyroidectomy as the most important modifiable risk factor for recurrence in this resource-poor setting, disproportionately affecting women and rural dwellers. In spite of possibly increased immediate complication risks on re-operations, total thyroidectomy at index operation has the potential to cure recurrence and is in accordance with international standards. Reforms at the institutional level must focus on training surgeons in total thyroidectomy methods, subsidize the availability of levothyroxine to alleviate postoperative hypothyroidism issues, and invest in
simple nerve preservation equipment. This research presents essential evidence for policy changes toward definitive surgical treatment of benign multinodular goitre in low-resource settings with a focus on prevention of unnecessary re-operations through enhanced initial treatment.