Follow‐up evaluation of thyroid function after thyroidectomy for thyrotoxicosis

Harada, Tanekazu; Shimaoka, Katsutaro; Arita, Seizaburo; Nakanishi, Yuri

doi:10.1007/bf01654907

Cited by 19 publications

(10 citation statements)

References 19 publications

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“…The extent of the surgical procedure in any given patient with Graves' disease is still a question of debate (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). in principle, surgery should be radical, espe¬ cially in young individuals, and it is a common experience that children under the age of 10 years may require total thyroidectomy to avoid the risk of recurrence.…”

Section: Discussionmentioning

confidence: 99%

Graves' disease in children and adolescents. Late results of surgical treatment

Rudberg

Johansson

Åkerström

et al. 1996

European Journal of Endocrinology

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All children and adolescents with Graves' disease in the county of Uppsala (catchment area population 250,000) treated between 1970 and 1994 were evaluated in a retrospective study. The material comprised 31 patients with a mean age of 11 years (range 4-16), 29 (94%) of whom were girls, and four (13%) of the patients had Down's syndrome. Treatment was primarily conservative and surgery was considered if prolonged medical treatment failed. Lasting remission after antithyroid drug therapy (median 6.5 years; range 4.5-8 years) was noted in 6/31 patients (19%), three (10%) of whom subsequently developed hypothyroidism. Twenty-four of the remaining patients (77%) ultimately underwent subtotal (N = 20) or total thyroidectomy (N = 4) after experiencing one or more episodes of recurrent hyperthyroidism during medical treatment (median 6 years; range 0.5-11 years). After surgery one patient developed permanent hypocalcemia requiring low-dose vitamin D supplementation. During a postoperative follow-up period of 12.2 years ( median; range 1-17 years), there were two cases of recurrent thyrotoxicosis, 1 and 10 years after surgery. The results underline that gender and Down's syndrome are risk factors of juvenile Graves' disease and that the disorder often is difficult to control by long-term medical therapy. In such cases thyroid surgery offers a safe and prompt reversal of the thyrotoxicosis. A proportion of the patients may ultimately develop hypothyroidism, substantiating a need for long-term follow-up of persons afflicted with Graves' disease early in life.

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Section: Discussionmentioning

confidence: 99%

Graves' disease in children and adolescents. Late results of surgical treatment

Rudberg

Johansson

Åkerström

et al. 1996

European Journal of Endocrinology

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“…Although many reports about factors related to postop¬ erative thyroid dysfunction have been published (3,(20)(21)(22)(23), definite factors remain unknown except for the remnant size of the thyroid and levels of antimicrosomal antibod¬ ies (7,23).…”

Section: Discussionmentioning

confidence: 99%

Results of Subtotal Thyroidectomy for Graves' Disease

Chou¹,

Wang²,

Huang³

1999

Thyroid

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The objective of this study was to find the factors responsible for hypothyroidism after subtotal thyroidectomy for Graves' disease. Two hundred five patients who were operated on from July 1989 to December 1997 were studied. The mean age of patients was 33.4+/-11.0 (mean +/- SD) years, and 175 (85.4%) were female. Patients were prepared with an antithyroid drug and Lugol's solution preoperatively. Triiodothyronine (T3), thyroxine (T4), thyrotropin (TSH), thyrotropin-binding immunoglobulins (TBII) antimicrosomal antibodies (AMA = 100x 4(M-1)), and antithyroglobulin antibodies (ATA = 100x4(T-1)) were measured 1 week before patients were operated on. Operations were performed according to the standard procedure with 2.5x1x1 cm of thyroid tissue remaining on each side before approximating the thyroid capsule and pretracheal fascia. Hypothyroidism was defined by patients with overt hypothyroidism in laboratory data, and or with T4 to maintain T3 and T4. Two hundred two patients were checked 3 months after being operated on. Latent hyperthyroidism was found in 22, euthyroidism in 55, latent hypothyroidism in 91, hypothyroidism in 34 (16.8%) and none were in overt hyperthyroidism. After a follow-up period of 26.9+/-15 (mean +/- SD) months, 199 patients were reevaluated. Overt hyperthyroidism was found in 2 patients, latent hyperthyroidism in 12, euthyroidism in 97, latent hypothyroidism in 72, and hypothyroidism in 16 (8%). Factors having possible effects on hypothyroidism after longterm follow-up were analyzed. Patient's age, gender, body surface, premedicative T3 and T4, preoperative ATA, and TBII, and the weight of removed thyroid had no effect on the occurrence of hypothyroidism. Preoperative AMA levels, and finding more than 10 lymphoid infiltrations per 10 low-power fields (x40) were significantly different between the hypothyroid and nonhypothyroid groups. A high level of preoperative AMA was the only factor independently causing overt hypothyroidism in the follow-up period. Patients with high preoperative AMA levels have a higher risk of hypothyroidism if only 2.5x1x1 cm remnants are left on each side.

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“…Die Hauptindikation zur Operation war, wie auch bei anderen Autoren [24,55] [47], die auch dutch eine antithyreoidale Therapie nicht ausreichend beeinfluBt werden kann. Darfiber hinaus konnte gezeigt werden, daB mit zunehmender Strumagr6Be auch die Rate funktioneller Rezidive deutlich zunimmt [31].…”

Section: Materials Und Methodenunclassified

Operatives Therapiekonzept der Immunthyreopathie

Dralle

Schober

Hesch

1987

Langenbecks Arch Chiv

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73 patients with Graves' disease, surgically treated from 1975-1986, were investigated retrospectively. 43 patients, treated by subtotal thyroidectomy (Enderlen-Hotz) and a bilateral thyroid remnant of a total of about 8-12 g, were compared with 30 patients, treated by a modified subtotal thyroidectomy leaving a unilateral thyroid remnant of about 4-8 g, with respect to preoperative duration of disease, indications for surgical treatment, weight of resected specimens, operative complications and postoperative thyroid function. Surgical complications were similar in both groups. After subtotal thyroidectomy 14/43 patients (33%) displayed either recurrent hyperthyroidism (9/43, 21%) or local recurrence of Graves' goiter (3/43, 7%) or both (2/43, 5%). The modified subtotal resected group showed no recurrences of the disease. After subtotal thyroidectomy 11 patients were euthyroid without thyroid medication (26%) compared to only two patients (7%) after the modified procedure of subtotal thyroid resection. To prevent recurrences of goiter as well as hyperthyroidism and, on the other hand, to achieve euthyroid function postoperatively without need for thyroid replacement therapy, subtotal thyroidectomy with a small thyroid remnant of about 4-8 g is recommended for all patients with large goiter and a chronic recurrent course of the disease or with iodine induced thyrotoxicosis. Patients with non-recurrent Graves' disease but large goiter probably benefit from subtotal thyroidectomy with a larger thyroid remnant of about 8-12 g.

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Follow‐up evaluation of thyroid function after thyroidectomy for thyrotoxicosis

Cited by 19 publications

References 19 publications

Graves' disease in children and adolescents. Late results of surgical treatment

Graves' disease in children and adolescents. Late results of surgical treatment

Results of Subtotal Thyroidectomy for Graves' Disease

Operatives Therapiekonzept der Immunthyreopathie

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