title: Total thyroidectomy: a safe and effective treatment for Graves' disease.
abstract: BACKGROUND
  Thyroidectomy as a first line treatment for Graves' disease is rarely utilized in the US. The purpose of this study was to analyze the safety and efficacy of thyroid surgery among patients with Graves' disease.
  
  
  METHODS
  Fifty-six patients with Graves' disease underwent thyroid surgery between May 1994 and May 2008 at a single academic institution. Preoperative, intraoperative, and postoperative variables were analyzed.
  
  
  RESULTS
  A total of 58 surgeries were performed: 55.1% (n = 32) total thyroidectomy, 41.3% (n = 24) subtotal/lobectomy, 3.4% (n = 2) completion thyroidectomy. The average gland weight was 47.3 ± 10.8 gm, with 70% weighing > 30 gm. Reasons for having thyroid surgery were persistent disease despite medical therapy (46.6%), patient preference (24.1%), multinodular goiter/cold nodules (20.3%), failed RAI (radioactive iodine) treatment (16%), and opthalmopathy (12.1%). Of those patients that failed prior RAI therapy, the only factor that was predictive of failure was disease severity, as demonstrated by a markedly elevated initial free-T4 value (11.8 ± 4.5 ng/dL, P = 0.04). Transient symptomatic hypocalcemia occurred in 10.7% (n = 6) of patients, and one patient (1.8%) had symptomatic hypocalcemia lasting > 6 mo. There were no permanent recurrent laryngeal nerve injuries. There was no difference in overall complication rates between patients based on surgical procedure (subtotal versus total thyroidectomy), preoperative RAI treatment, or gland size. Recurrences occurred in 6% of the subtotal thyroidectomy group and 0% of the total thyroidectomy group (P = 0.008).
  
  
  CONCLUSIONS
  Thyroidectomy for patients with Graves' disease can be performed with very low complication rates and when a total thyroidectomy is performed, there is almost no risk of recurrence.
authors.affiliation: Department of Surgery, Section of Endocrine Surgery, University of Wisconsin, Madison, Wisconsin 53792, USA.
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.forename: Anna
authors.initials: A
authors.lastname: Bargren
authors.forename: Sarah
authors.initials: S
authors.lastname: Schaefer
authors.forename: Herbert
authors.initials: H
authors.lastname: Chen
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Sippel
mesh_terms: D000328:Adult; D005260:Female; D006111:Graves Disease / Q000601:surgery*; D006801:Humans; D006996:Hypocalcemia / Q000453:epidemiology; D007823:Laryngeal Nerves; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods*; D016896:Treatment Outcome