title: Graves' ophthalmopathy as an indication increased the risk of hypoparathyroidism after bilateral thyroidectomy.
abstract: BACKGROUND
  Studies have evaluated the effect of thyroidectomy on the course of Graves' ophthalmopathy (GO) but it is unclear how GO as an indication might affect surgical outcomes. We aimed to evaluate the impact of this indication on surgical outcomes in Graves' disease (GD).
  
  
  METHODS
  From 1995 to 2008, 329 patients with GD underwent thyroidectomy. Patients were stratified into two groups, namely, those with GO as indication (GO) and those with non-GO indication (non-GO). Outcomes were compared between the groups and outcomes with significance were further analyzed by multivariate analyses to determine independent factors.
  
  
  RESULTS
  The GO group was significantly older (P < 0.001), had more males (P < 0.001), and fewer relapses (P < 0.001) than the non-GO group. It also had a higher proportion of total/near-total thyroidectomy (P < 0.001), despite a shorter operating time (P = 0.024) and less blood loss (P = 0.010). When only total/near-total thyroidectomy was considered, the GO group had significantly more permanent hypoparathyroidism than the non-GO group (9.2 vs. 1.6%, P = 0.038), but the rate of permanent hypoparathyroidism was similar in the two groups when only those with parathyroid autotransplantation were considered. Other complications were similar between the two groups. By multivariate analysis, GO as indication was an independent risk factor for temporary (OR 1.97, P = 0.033) and permanent hypoparathyroidism (OR 4.76, P = 0.007).
  
  
  CONCLUSIONS
  GO as a surgical indication (i.e., unstable or active GO requiring ophthalmic treatment or follow-up) was associated with increased risk of temporary and permanent hypoparathyroidism after bilateral thyroidectomy. Routine parathyroid autotransplantation may reduce the risk of permanent hypoparathyroidism in this select patient group.
authors.affiliation: Division of Endocrine Surgery, Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong, Hong Kong. benwongkp@gmail.com
authors.forename: Kai-Pun
authors.initials: KP
authors.lastname: Wong
authors.forename: Brian Hung-Hin
authors.initials: BH
authors.lastname: Lang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D049970:Graves Ophthalmopathy / Q000601:surgery*; D006801:Humans; D007011:Hypoparathyroidism / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods; D055815:Young Adult