title: Surgical treatment of Graves' disease: subtotal or total thyroidectomy?
abstract: BACKGROUND
  The extent of thyroidectomy in Graves' disease is still controversial. We compared the outcome of two groups of patients with Graves' disease who underwent total and subtotal thyroidectomy, respectively.
  
  
  METHODS
  One hundred forty patients were treated by subtotal (ST, n = 80) or total thyroidectomy (TT, n = 60) between 1988 and 1994 for a large goiter or recurrence of hyperthyroidism after antithyroid drugs. Surgical complications, relapse of hyperthyroidism, and serum levels of antibodies were evaluated.
  
  
  RESULTS
  Thyroid-stimulating hormone receptor and thyroperoxidase antibodies significantly decreased in 44 of 60 and in 27 of 60, respectively, of TT patients and in 65 of 80 and 8 of 80, respectively, of ST patients. Thyroid-stimulating hormone antibody levels increased in three ST patients who had relapse of hyperthyroidism and in no TT patients; thyroperoxidase antibodies increased in nine ST patients (four with relapse of hyperthyroidism) and in no TT patients. Vocal cord palsy occurred in two ST (2.5%) and in 1 TT (1.7%) patients; hypoparathyroidism occurred in three ST (3.8%) and in two (3.3%) TT patients.
  
  
  CONCLUSIONS
  Total thyroidectomy does not present more complications with respect to subtotal thyroidectomy, but it avoids the worsening of thyroid humoral autoimmunity and the relapse of hyperthyroidism. Thus it could represent the treatment of choice in Graves' disease.
authors.affiliation: Department of Surgery, University of Pisa, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Miccoli
authors.forename: P
authors.initials: P
authors.lastname: Vitti
authors.forename: T
authors.initials: T
authors.lastname: Rago
authors.forename: P
authors.initials: P
authors.lastname: Iacconi
authors.forename: L
authors.initials: L
authors.lastname: Bartalena
authors.forename: F
authors.initials: F
authors.lastname: Bogazzi
authors.forename: E
authors.initials: E
authors.lastname: Fiore
authors.forename: R
authors.initials: R
authors.lastname: Valeriano
authors.forename: L
authors.initials: L
authors.lastname: Chiovato
authors.forename: R
authors.initials: R
authors.lastname: Rocchi
authors.forename: A
authors.initials: A
authors.lastname: Pinchera
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001323:Autoantibodies / Q000032:analysis; D002291:Carcinoma, Papillary / Q000150:complications; D002648:Child; D005260:Female; D006111:Graves Disease / Q000150:complications / Q000276:immunology / Q000601:surgery*; D006801:Humans; D007037:Hypothyroidism / Q000209:etiology; D007453:Iodide Peroxidase / Q000276:immunology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011184:Postoperative Period; D011989:Receptors, Thyrotropin / Q000276:immunology; D012008:Recurrence; D013964:Thyroid Neoplasms / Q000150:complications; D013965:Thyroidectomy / Q000379:methods*; D013972:Thyrotropin / Q000276:immunology
chemical_list: D001323:Autoantibodies; D011989:Receptors, Thyrotropin; D013972:Thyrotropin; D007453:Iodide Peroxidase