title: Should total thyroidectomy become the preferred procedure for surgical management of Graves' disease?
abstract: This study aims to evaluate our institution's experience with thyroidectomy for Graves' disease, with an emphasis on indications and long-term outcomes. The study cohort consisted of 103 patients (mean age 34.3 [+/-13.9] years), who underwent thyroidectomy for Graves' disease between 1991 and 2002. Clinical and follow-up data were obtained by retrospective review of medical records and by contacting treating physicians or patients. The most common surgical indications were patient preference (26%), cold nodule (24%), eye symptoms (20%), large goiter size (18%), allergy to antithyroidal medications (15%), and age younger than 16 years (14%). Thyroidectomies performed included 45 (total or near-total), 57 subtotal, and 1 lobectomy. Transient complications included hypocalcemia in 42 patients, and recurrent laryngeal nerve palsy in 5 patients. There was no difference in the frequency of hypocalcemia in patients undergoing total or subtotal resections. One patient developed permanent hypocalcemia and 2 permanent recurrent laryngeal nerve (RLN) injury. Only 3 patients who underwent subtotal resections remain off thyroxine and 2 developed recurrent hyperthyroidism approximately 17 and 54 months after surgery. Subtotal thyroidectomy is associated with a high rate of hypothyroidism and large remnants have potential for recurrence. Total or near-total thyroidectomy obviates these disadvantages and can be performed without increased complication rates, thus appearing to be the preferred extent of thyroidectomy for Graves' disease.
authors: Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
authors: Geeta
authors: G
authors: Lal
authors: Philip
authors: P
authors: Ituarte
authors: Electron
authors: E
authors: Kebebew
authors: Allan
authors: A
authors: Siperstein
authors: Quan-Yang
authors: QY
authors: Duh
authors: Orlo H
authors: OH
authors: Clark
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006111:Graves Disease / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013961:Thyroid Gland / Q000601:surgery; D013965:Thyroidectomy / Q000592:standards / Q000706:statistics & numerical data; D016896:Treatment Outcome