[Subtotal resection of thyroid gland - optimal method for threatment of Bazedow disease. Prognosis].
Subtotal thyroidectomy is a widely accepted surgical procedure for Basedow disease. The purpose of this work is to evaluate functional long-term results and determine predictive prognostic factors of postoperative thyroid function. This is a retrospective study conducted on 207 patients with Basedow disease undergoing subtotal thyroidectomy during the period 1983-2004. Predictive prognostic factors of final thyroid status were investigated and probability of hypothyroidism during the years of follow-up was obtained by the Kaplan-Meier method. Surgery controlled hyperthyroidism in 199 out of 207 patients (97%). The probability of hypo-, eu-, and hyperthyroidism at 5 years was 63%, 36%, and 2%, respectively. No statistical change in thyroid function occurred in the follow-up after 5 years. 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. Subtotal thyroidectomy controlled hyperfunction symptoms in 97% of our patients. Cure (euthyroidism) of Basedow 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. No need for long term medical therapy is emphasised.
Kŭtev
N
N
Departement of Surgery,Clinic of general surgery, University Hospital Alexandrovska Bulgaria, Sofia.
Petkov
R
R
Iarŭmov
N
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006111:Graves Disease / Q000097:blood / Q000473:pathology / Q000601:surgery*; D006801:Humans; D006980:Hyperthyroidism / Q000453:epidemiology / Q000209:etiology; D007037:Hypothyroidism / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011379:Prognosis; D012189:Retrospective Studies; D013960:Thyroid Function Tests; D013961:Thyroid Gland / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*