World Journal of Surgery

, Volume 43, Issue 4, pp 1022–1028 | Cite as

Thyroidectomy Then and Now: A 50-Year Australian Perspective

  • Belinda Hii
  • Dominic Maher
  • Meei Yeung
  • Eldho Paul
  • Jonathan W. Serpell
  • James C. LeeEmail author
Original Scientific Report



Since the mid-1800s, thyroidectomy has transformed from a procedure associated with high to near-zero mortality. Nonetheless, surgeons must continue to strive to improve patient care. Using historical records and contemporary data, this study compares the practice and outcomes of thyroid surgery at a tertiary institution during two periods, 50 years apart.


‘The Alfred Hospital Clinical Reports’ recorded all cases of surgically managed thyroid disease from 1946 to 1959. These historical cases were compared to contemporary thyroidectomy cases at the Alfred Hospital from 2007 to 2016. Cases were compared for surgical indication and post-operative outcomes.


There were 746 patients in the historical group (mean age 53 years; 87% female) and 787 patients in the contemporary group (mean age 52 years; 80% female). The most common indication for thyroidectomy in both groups was non-toxic nodular goitre. A greater proportion of the contemporary group were diagnosed with thyroid malignancy (27% vs. 8%; p < 0.001). The contemporary group recorded significantly fewer cases of thyrotoxic crisis (2.1% vs. 0%; p = 0.001), permanent nerve palsy (4.6% vs. 0.4%; p < 0.001) and bilateral nerve palsy (1.2% vs. 0%; p = 0.01). There were no mortalities in the contemporary group, while the historical data recorded three deaths (0.44%).


This study compared thyroid surgery in two cohorts separated by a 50-year period. While it is not surprising that outcomes of thyroidectomy have improved, this study uniquely demonstrates trends of thyroid surgery over time and areas in which further improvements may be made.



The authors would like to acknowledge all the surgeons who have contributed cases to the MUESU database, Mr Chhavi Bhatt for maintaining the database and Dr Christine Ball for curating the historical archives.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Sarkar S, Banerjee S, Sarkar R et al (2016) A review on the history of ‘thyroid surgery’. Indian J Surg 78:32–36CrossRefPubMedGoogle Scholar
  2. 2.
    Giddings AE (1998) The history of thyroidectomy. J R Soc Med 91(Suppl 33):3–6CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Welbourn R (ed) (1990) The thyroid. In: The history of endocrine surgery. Praeger, New York, pp 19–27Google Scholar
  4. 4.
    Halsted W (1920) The operative story of goitre. Johns Hopkins Hosp Rep 19:169Google Scholar
  5. 5.
    Hannan SA (2006) The magnificent seven: a history of modern thyroid surgery. Int J Surg 4:187–191CrossRefPubMedGoogle Scholar
  6. 6.
    Becker WF (1977) Presidential address: pioneers in thyroid surgery. Ann Surg 185:493–504CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Vellar ID (1974) Thomas Peel Dunhill, the forgotten man of thyroid surgery. Med Hist 18:22–50CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Hamilton N (1960) Review of thyroidectomy at the Alfred Hospital: 1946–59. Alfred Hosp 10:11–19Google Scholar
  9. 9.
    Cancer in Australia (2017) Canberra. AIHW 2017:37Google Scholar
  10. 10.
    Lim H, Devesa SS, Sosa JA et al (2017) Trends in thyroid cancer incidence and mortality in the United States, 1974–2013. JAMA 317:1338–1348CrossRefPubMedGoogle Scholar
  11. 11.
    Morris LGT, Myssiorek D (2010) Improved detection does not fully explain the rising incidence of well-differentiated thyroid cancer: a population-based analysis. Am J Surg 200:454–461CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Adam MA, Thomas S, Youngwirth L et al (2017) Is there a minimum number of thyroidectomies a surgeon should perform to optimize patient outcomes? Ann Surg 265:402–407CrossRefPubMedGoogle Scholar
  13. 13.
    Loyo M, Tufano RP, Gourin CG (2013) National trends in thyroid surgery and the effect of volume on short-term outcomes. Laryngoscope 123:2056–2063CrossRefPubMedGoogle Scholar
  14. 14.
    Rosato L, Avenia N, Bernante P et al (2004) Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg 28:271–276. CrossRefPubMedGoogle Scholar
  15. 15.
    Jeannon JP, Orabi AA, Bruch GA et al (2009) Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: a systematic review. Int J Clin Pract 63:624–629CrossRefPubMedGoogle Scholar
  16. 16.
    Vasileiadis I, Karatzas T, Charitoudis G et al (2016) Association of intraoperative neuromonitoring with reduced recurrent laryngeal nerve injury in patients undergoing total thyroidectomy. JAMA Otolaryngol Head Neck Surg 142:994–1001CrossRefPubMedGoogle Scholar
  17. 17.
    Pardal-Refoyo JL, Ochoa-Sangrador C (2016) Bilateral recurrent laryngeal nerve injury in total thyroidectomy with or without intraoperative neuromonitoring. Systematic review and meta-analysis. Acta Otorrinolaringol Esp 67:66–74CrossRefPubMedGoogle Scholar
  18. 18.
    Lee JC, Wong SL, Johnson W et al (2015) Electromyographic amplitude changes in the laryngeal adductors during thyroidectomy with vagal nerve stimulation: a marker of tensile stress in the recurrent laryngeal nerve? Int J Surg Res Pract 2:1–5CrossRefGoogle Scholar
  19. 19.
    Serpell JW, Lee JC, Chiu WK et al (2015) Stressing the recurrent laryngeal nerve during thyroidectomy. ANZ J Surg 85:962–965CrossRefPubMedGoogle Scholar
  20. 20.
    Serpell JW, Lee JC, Yeung MJ et al (2014) Differential recurrent laryngeal nerve palsy rates after thyroidectomy. Surgery 156:1157–1166CrossRefPubMedGoogle Scholar
  21. 21.
    Lee JC, Breen D, Scott A et al (2016) Quantitative study of voice dysfunction after thyroidectomy. Surgery 160:1576–1581CrossRefPubMedGoogle Scholar
  22. 22.
    Farrar WB (1983) Complications of thyroidectomy. Surg Clin North Am 63:1353–1361CrossRefPubMedGoogle Scholar
  23. 23.
    Lacoste L, Gineste D, Karayan J et al (1993) Airway complications in thyroid surgery. Ann Otol Rhinol Laryngol 102:441–446CrossRefPubMedGoogle Scholar
  24. 24.
    Liu J, Sun W, Dong W et al (2017) Risk factors for post-thyroidectomy haemorrhage: a meta-analysis. Eur J Endocrinol 176:591–602CrossRefPubMedGoogle Scholar
  25. 25.
    Gough IR (1992) Total thyroidectomy: indications, technique and training. Aust N Z J Surg 62:87–89CrossRefPubMedGoogle Scholar
  26. 26.
    Lee JC, Chang P, Grodski S, et al (2016) Temporal analysis of thyroid cancer management in a Melbourne tertiary centre. ANZ J Surg. Google Scholar
  27. 27.
    Delbridge L (2003) Total thyroidectomy: the evolution of surgical technique. ANZ J Surg 73:761–768CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Belinda Hii
    • 1
  • Dominic Maher
    • 1
  • Meei Yeung
    • 1
  • Eldho Paul
    • 3
    • 4
  • Jonathan W. Serpell
    • 1
    • 2
  • James C. Lee
    • 1
    • 2
    Email author
  1. 1.Department of General Surgery, Monash University Endocrine Surgery UnitThe Alfred HospitalMelbourneAustralia
  2. 2.Department of SurgeryMonash UniversityMelbourneAustralia
  3. 3.Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
  4. 4.Clinical Haematology DepartmentAlfred HospitalMelbourneAustralia

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