Subtotal thyroidectomy: a reliable method to achieve euthyroidism in Graves' disease. Prognostic factors.
BACKGROUND
Subtotal thyroidectomy is a widely accepted surgical procedure for Graves' disease. The purpose of this work is to evaluate functional long-term results and determine predictive prognostic factors of postoperative thyroid function.


METHODS
This is a retrospective study conducted on 202 patients with Graves' disease undergoing subtotal thyroidectomy during the period 1979-2002. Predictive prognostic factors of final thyroid status were investigated by logistic ordinal regression, and probability of hypothyroidism during the years of follow-up was obtained by the Kaplan-Meier method.


RESULTS
Surgery controlled hyperthyroidism in 196 out of 202 patients (97%). The probability of hypo-, eu-, and hyperthyroidism at 5 years was 62.1%, 35.5%, and 2.4%, respectively. No statistical change in thyroid function occurred in the follow-up after 60 months. Multivariate analysis by a logistic ordinal regression analysis showed that weight of the remnant, age, and gender seemed to influence long-term thyroid function. The higher rates of euthyroidism were obtained when the remnant weight was between 6 and 8 g. No recurrence or persistence of hyperthyroidism occurred with remnant weights under 5 g.


CONCLUSIONS
Subtotal thyroidectomy controlled hyperfunction symptoms in 97% of our patients. Cure (euthyroidism) of Graves' disease patients should be attempted by leaving a thyroid tissue remnant between 6 and 8 g. Even more significant, our results suggest that euthyroidism rates could be improved by leaving a smaller remnant in elderly women and greater remnants in young men.
Moreno
Pablo
P
Servicio de Cirugía General y Digestiva, Ciudad Sanitaria y Universitaria de Bellvitge, Barcelona, Spain. 25108pml@comb.es
Gómez
José M
JM
Gómez
Núria
N
Francos
José M
JM
Ramos
Emilio
E
Rafecas
Antonio
A
Jaurrieta
E
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006111:Graves Disease / Q000601:surgery*; D006801:Humans; D006980:Hyperthyroidism / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013965:Thyroidectomy / Q000379:methods*