title: Changing trends in surgery for Graves' disease: a cohort comparison of those having surgery intended to preserve thyroid function with those having ablative surgery.
abstract: BACKGROUND
  Surgery for Graves' disease may be performed with the intent of preserving thyroid function (subtotal thyroidectomy) or ablating thyroid function (total thyroidectomy). This study examines the evolving practice in a specialist endocrine surgical unit.
  
  
  METHODS
  Longitudinal cohort study of patients undergoing surgery for Graves' disease between 1986 and 2008. Outcome measures were thyroid failure, recurrent toxicity, recurrent laryngeal nerve (RLN) palsy, early reoperation and hypocalcaemia. Time to thyroid failure was analysed by potential predictors.
  
  
  RESULTS
  Of 149 patients (129 female), 78 (52.3 percent) underwent subtotal thyroidectomy with the intention to preserve function (PF) and 71 (47.6 percent) total thyroidectomy with the intention to ablate thyroid function (AF). Mean duration of follow-up was 11.1 years; 14.8 years and 7.0 years respectively. Of 78 PF procedures: six (7.7 percent) patients suffered recurrent toxicity; 68 (87.2 percent) developed thyroid failure (four after treatment for recurrent toxicity); and eight (10 percent) remained euthyroid without replacement. Male gender and remnant gland weight were significant predictors of failure (P = 0.021 and 0.022 respectively). One patient developed permanent RLN palsy and one permanent hypocalcaemia. Of 71 AF procedures: one developed acute airway obstruction; one permanent RLN palsy; four permanent hypocalcaemia; and none developed recurrent toxicity. There were no deaths within a year of surgery. There was no statistically significant difference in complication rates.
  
  
  CONCLUSIONS
  Most PF resections resulted in eventual thyroid failure. The shift to ablative surgery virtually eliminated the need for lifelong specialist follow-up, albeit with an insignificant rise in permanent hypocalcaemia.
authors.affiliation: Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK. zhk@abdn.ac.uk.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Adhami
authors.forename: Ailsa C
authors.initials: AC
authors.lastname: Snaith
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Craig
authors.forename: Zygmunt H
authors.initials: ZH
authors.lastname: Krukowski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006111:Graves Disease / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D013961:Thyroid Gland / Q000503:physiopathology; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods / Q000639:trends*; D014826:Vocal Cord Paralysis / Q000453:epidemiology; D055815:Young Adult