title: Evaluation of the operative methods for Graves' disease.
abstract: OBJECTIVE
  In Japan, surgery for Graves' disease (GD), which is considered to be a radical therapy, has been restricted by various guidelines. Nevertheless, some patients benefit from surgery. We sought to identify a reasonable operative method for GD by comparing the efficacy and safety among patients undergoing different extents of thyroidectomy.
  
  
  METHODS
  A total of 162 patients underwent thyroidectomy for GD between 2003 and 2012 in our department. We compared the clinical factors among those who underwent subtotal thyroidectomy (ST), near-total thyroidectomy (NTT), and total thyroidectomy (TT).
  
  
  RESULTS
  The ST, NTT, and TT groups included 111, 21, and 30 patients, respectively. The patient sex, period between disease onset and surgery, and preoperative thyroidal function were not substantially different among the three groups. With regard to surgical variables, the duration of surgery, amount of blood loss, and postoperative length of hospitalization were not substantially different among the three groups. Postoperative recurrent laryngeal nerve (RLN) palsy was transient in all cases, but the rate was significantly higher in the TT group compared to the other two groups (P<0.001). The incidences of transient hypocalcemia and permanent hypoparathyroidism were not substantially different among the groups. The proportion of patients who required the postoperative administration of levothyroxine was significantly lower in the ST group compared to the TT and NTT groups. Hyperthyroidism recurrence was noted in eight patients in the ST group (7.2%).
  
  
  CONCLUSIONS
  NTT for GD is thus considered to be a reasonable operative method regarding both efficacy and safety.
authors.affiliation: Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan - ymanouch@gk9.so-net.ne.jp.
authors.forename: K
authors.initials: K
authors.lastname: Yamanouchi
authors.forename: S
authors.initials: S
authors.lastname: Minami
authors.forename: S
authors.initials: S
authors.lastname: Kuba
authors.forename: C
authors.initials: C
authors.lastname: Sakimura
authors.forename: N
authors.initials: N
authors.lastname: Hayashida
authors.forename: F
authors.initials: F
authors.lastname: Kawakami
authors.forename: T
authors.initials: T
authors.lastname: Kuroki
authors.forename: S
authors.initials: S
authors.lastname: Eguchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006111:Graves Disease / Q000601:surgery*; D006801:Humans; D007564:Japan; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome