Early recurrence of hyperthyroidism in patients with Graves' disease treated by subtotal thyroidectomy

Abstract

Prerequisites for surgical treatment of Graves' disease are that it can be done safely and that it is associated with a low incidence of recurrent hyperthyroidism. Early recurrence is especially undesirable. We studied 728 patients with Graves' disease treated by subtotal thyroidectomy using multivariate analysis in order to determine the factors related to early recurrence. The following factors were analyzed: age, sex, duration of medical treatment, weight of resected thyroid tissue, thyroid remnant size, preoperative level of thyroid-stimulating hormone (TSH) binding inhibitory immunoglobulin (TBII), and antimicrosomal hemagglutination antibody (MCHA). "Early recurrence" was defined as TSH suppression observed within the first year after surgery and continuing for at least 6 months. A total of 106 patients (14.6%) had early recurrence. Statistical analyses were performed by the chi-square test for univariate analysis and a logistic model for multivariate analysis. Significant factors were thyroid remnant size, MCHA, and TBII. These results indicated that TBII and MCHA are related to early recurrence of hyperthyroidism, and smaller remnant size is recommended for patients with a high MCHA titer or a high TBII level (or both) in order to avoid early recurrence.

Surgical Management of Graves' Disease -10-year Prospective Trial at a Single Institution-

“…We think the ideal goal is not euthyroidism with thyroxin replacement therapy, but long-term euthyroidism without medication. Factors related to postoperative thyroid dysfunction, especially recurrent hyperthyroidism, had to be elucidated to achieve this goal and we have published several reports and concluded that thyroid remnant size is the only powerful factor related to postoperative thyroid dysfunction [4,15]. Risk factor analyses showed that female patients with high preoperative TBII level had recurrent overt hyperthyroidism.…”

Fetal cell carcinogenesis of the thyroid: A modified theory based on recent evidence [My Opinion]

“…Fetal thyroid cells, especially TSCs and thyroblasts, are not likely to exist abundantly in the thyroid in adults, since the adult thyroid does not usually regenerate after partial thyroidectomy [22]. No induction of thyroid carcinomas by radiation in adults supports this assumption [11].…”

Changes in the thyroid function of Graves’ disease patients treated by subtotal thyroidectomy

“…However, in our previous study, 18 % of the Graves' disease patients treated by subtotal thyroidectomy developed recurrent hyperthyroidism after 8 years postoperatively [16] and that was an unacceptably high rate. Factors related to postoperative thyroid dysfunction, especially recurrent hyperthyroidism, had to be elucidated to achieve the ideal goal, and we have published several reports [2,3] and concluded that thyroid remnant size is the only powerful factor associated with postoperative thyroid dysfunction. Although thyroid remnant size is a significant factor related to postoperative thyroid dysfunction, patients with almost the same size thyroid remnant do not always have the same postoperative clinical course.…”

“…In our previous studies, preoperative TSH receptor antibody levels have a significant effect on the short-term results of subtotal thyroidectomy for Graves' disease but not on the long-term results. Long-term surgical outcomes could not be predicted on the basis of the preoperative TSH receptor antibody level [2,3].…”

“…Factors related to postoperative thyroid dysfunction, especially recurrent hyperthyroidism, had to be elucidated to achieve a permanent remission without medication, and we have published several reports and concluded that thyroid remnant size is the only powerful factor related to postoperative thyroid dysfunction [2,3]. We prospectively decreased thyroid remnant size as a strategy to reduce the postoperative hyperthyroidism relapse rate, but our strategy resulted in an increase in patients with hypothyroidism [4].…”