title: Surgical management of hyperthyroidism.
abstract: OBJECTIVE
  Hyperthyroidism includes several clinical and histopathological situations. Surgery is commonly indicated after failure of medical treatment. The aim of this study was to analyze the indications and complications of surgery as well as endocrine results.
  
  
  METHODS
  Patients operated on for hyperthyroidism between 2004 and 2012 were included in a retrospective study. Total thyroidectomy was performed for Graves' disease, toxic multinodular goiter and amiodarone-associated thyrotoxicosis; patients with toxic nodule underwent hemithyroidectomy. Pathologic analysis assessed surgical specimens; postoperative complications and resolution of hyperthyroidism were noted.
  
  
  RESULTS
  Two hundred patients from 15 to 83 years old were included. One hundred and eighty-eight underwent primary surgery and 12 were re-operated for recurrent goiter (6 with subtotal thyroidectomy for multinodular goiter 25 years previously; 6 with hemithyroidectomy for solitary nodule 15 years previously). Eighty-two patients suffered from toxic multinodular goiter, 78 from Graves' disease, 35 from solitary toxic nodules and 5 from amiodarone-associated thyrotoxicosis. Fourteen papillary carcinomas (including 11 papillary microcarcinomas) and 34 healthy parathyroid glands (17%) were identified in the pathological specimens. Postoperative complications comprised 4% permanent recurrent laryngeal nerve palsy (1 year follow-up), 9% hematoma requiring surgical revision, and 3% definitive hypocalcemia. Normalization of thyroid hormone levels was observed in 198 patients. Two recurrences occurred due to incomplete resection (1 case of Graves' disease and 1 intrathoracic toxic goiter that occurred respectively 18 and 5 months after resection). Postoperative complications were more frequent in multinodular goiter (23%) than in Graves' disease (13%) (ns: P>0.05).
  
  
  CONCLUSIONS
  Surgical management of hyperthyroidism enables good endocrinal control if surgery is complete. Patients need to be fully informed of all possible postoperative complications that could occur, especially vocal ones. Long-term follow-up is necessary to detect recurrence, which can occur more than 20 years after partial thyroidectomy surgery. Surgery allows early diagnosis of 12.5% of papillary carcinomas.
authors.affiliation: Service ORL et de Chirurgie Cervico-Faciale, Hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France. Electronic address: c.querat@yahoo.fr.
authors.forename: C
authors.initials: C
authors.lastname: Quérat
authors.affiliation: Service Endocrinologie - Diabète et Maladies Métaboliques, Hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
authors.forename: N
authors.initials: N
authors.lastname: Germain
authors.affiliation: Laboratoire d'Anatomie et Cytologie Pathologique, Hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Dumollard
authors.affiliation: Service Endocrinologie - Diabète et Maladies Métaboliques, Hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
authors.forename: B
authors.initials: B
authors.lastname: Estour
authors.affiliation: Laboratoire d'Anatomie et Cytologie Pathologique, Hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
authors.forename: M
authors.initials: M
authors.lastname: Peoc'h
authors.affiliation: Service ORL et de Chirurgie Cervico-Faciale, Hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne cedex 2, France.
authors.forename: J-M
authors.initials: JM
authors.lastname: Prades
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000601:surgery; D005260:Female; D006044:Goiter, Nodular / Q000601:surgery; D006111:Graves Disease / Q000601:surgery; D006801:Humans; D006980:Hyperthyroidism / Q000175:diagnosis / Q000601:surgery*; D006996:Hypocalcemia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology
keywords: Graves’ disease; Hyperthyroidism; Hypocalcemia; Recurrent laryngeal nerve palsy; Thyroidectomy; Toxic multinodular goiter