Retrospective evaluation of subtotal and total thyroidectomy in Graves' disease with and without endocrine ophthalmopathy.
A retrospective analysis was performed in 173 consecutive patients with Graves' disease (GD) with the principal aim of evaluating the influences of subtotal (N = 157) and total (N = 19) thyroidectomy on postoperative recurrence rates, endocrine ophthalmopathy (EO) and thyrotropin receptor antibody (TSH-R-ab) titres. Postoperatively recurrent disease, identified by increased thyroid hormone levels, occurred in 32 patients (20%) who underwent subtotal resection. These recurrences were associated with over-representation of preoperative EO (p < 0.001) as well as high TSH-R-ab levels postoperatively (p < 0.05-0.01). Subtotal and total resections were followed by an aggravation of preoperative EO in nine (16%) and one (6%), and by a development of EO in two and none of the patients, respectively. Persistently elevated TSH-R-ab titers during thyrostatic therapy became close to normalized in seven (32%) and 15 (88%) of the patients undergoing subtotal or total thyroidectomies, respectively, which illustrates a thyroid tissue dependency of the autoantibody production. Among the total material of 173 patients, altogether 75 cases exhibited persistent or progressive EO and/or TSH-R-ab elevation after more than 1 year of preoperative thyrostatic treatment. In this group, recurrent GD or aggravated EO occurred in 23 (39%) of those operated with subtotal resection and in one (6%) of those undergoing total thyroidectomy (p < 0.05). The results thus indicate that EO, particularly at the time of surgery, and prevailing TSH-R-ab titers are associated with an increased risk of recurrent GD and suggest that patients exhibiting these characteristics should benefit from total rather than subtotal thyroidectomy.
Winsa
B
B
Department of Internal Medicine, University Hospital, Uppsala, Sweden.
Rastad
J
J
Akerström
G
G
Johansson
H
H
Westermark
K
K
Karlsson
F A
FA
D000328:Adult; D000906:Antibodies / Q000276:immunology; D005128:Eye Diseases / Q000150:complications* / Q000276:immunology; D005260:Female; D005500:Follow-Up Studies; D006111:Graves Disease / Q000150:complications* / Q000276:immunology / Q000601:surgery*; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology; D007011:Hypoparathyroidism / Q000209:etiology; D008297:Male; D011989:Receptors, Thyrotropin / Q000032:analysis / Q000276:immunology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013965:Thyroidectomy / Q000009:adverse effects / Q000592:standards*; D014826:Vocal Cord Paralysis / Q000209:etiology
D000906:Antibodies; D011989:Receptors, Thyrotropin