title: Surgical treatment of Graves' disease: subtotal thyroidectomy might still be the preferred option.
abstract: OBJECTIVE
  The aim of this prospective study was to report our results after thyroidectomy for Graves' disease. In addition, the relationship between the thyroid remnant and postoperative thyroid function was studied.
  
  
  METHODS
  Forty-nine consecutive patients were operated on for Graves' disease. The indications for surgery were persistent or recurrent hyperthyroidism after medical treatment in 34 patients (69.4%), mechanical symptoms due to a large goiter in 7 (14.3%), increased ophthalmopathy in 7 (14.3%), and allergy to antithyroid medications in 1 patient (2.0%). Total thyroidectomy (TT) was performed in 28 and subtotal thyroidectomy (STT) in 21 patients. Follow-up lasted 24 to 70 months.
  
  
  RESULTS
  There was no statistically significant difference in the rate of postoperative complications comparing TT and STT. The patients who underwent TT had no recurrence during a mean follow-up of 47 months. After STT, with the mean weight of the thyroid remnant 3.0+/-1.0 g, there was no relapse of Graves' disease during a mean follow-up of 52 months. After STT, postoperative hypothyroidism developed in 14 patients (66.7%); 7 patients (33.3%) remained euthyroid during follow-up. Comparison of the euthyroid patients and the hypothyroid patients revealed no difference in the weight of the remnant (3.3 g vs. 2.8 g), but a statistically significant difference occurred in the weight of the resected gland (61.0 g vs. 94.4 g, P=0.026) and in the proportion of the remnant (5.6% vs. 3.3%, P=0.030).
  
  
  CONCLUSIONS
  Both TT and STT are safe procedures regarding postoperative complication rate. STT with the thyroid remnant of about 3 g allows to permanently cure hyperthyroidism ensuring the euthyroid state in a significant proportion of patients. Postoperative thyroid function after STT is best predicted by the proportion of the remnant.
authors.affiliation: Department of Surgery, University of Tartu, Tartu, Estonia. urmas.lepner@kliinikum.ee
authors.forename: Urmas
authors.initials: U
authors.lastname: Lepner
authors.forename: Indrek
authors.initials: I
authors.lastname: Seire
authors.forename: Veronika
authors.initials: V
authors.lastname: Palmiste
authors.forename: Ulle
authors.initials: U
authors.lastname: Kirsimägi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003627:Data Interpretation, Statistical; D005260:Female; D005500:Follow-Up Studies; D006111:Graves Disease / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D013908:Thoracotomy; D013965:Thyroidectomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome