The influence of remnant size, antithyroid antibodies, thyroid morphology, and lymphocyte infiltration on thyroid function after subtotal resection for hyperthyroidism

Abstract

The influence of thyroid remnant size, antithyroid antibody titre, thyroid morphology, and lymphocyte infiltration on postoperative thyroid function was studied in 179 patients undergoing subtotal thyroidectomy because of hyperthyroidism. The surgical procedure was strictiy standardized and included determination of the thyroid remnant size. The preoperative medication used was beta-adrenoceptor blocking agents in 101 patients and antithyroid drugs and thyroxine in 78. With remnant size adjusted to 6-10 g (or, in goiters less than 20 g, to 25-30% of initial gland weight), the overall recurrence rate after 2-8 years (mean 5.3 -+ 2.0) of follow-up was 1.7% and the incidence of thyroid hypofunction was 29.6%.In toxic nodular goiter (TNG; n = 63), a significant negative correlation was found between TSH and remnant size after 12 months as well as a significantly lower remnant weight in patients developing postoperative hypothyroidism. In toxic diffuse goiter (TDG; n = I16), there was no difference in remnant size between euthyroid and hypothyroid patients. For patients with TDG treated preoperatively with beta-blockers, the incidence of autoantibodies against thyroid cytoplasm was increased in patients who postoperatively developed thyroid dysfunction. Within the group of TDG developing hypofunction, we found increased titre of autoantibodies and "presence of lymphoid tissue" more often in patients treated preoperatively with beta-blockers compared to thyrostatics. In toxic nodular goiter, the remnant size was considered the parameter most helpful to the surgeon in predicting postoperative thyroid function.

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

“…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.…”

Surgical treatment of Graves’ disease: Subtotal thyroidectomy might still be the preferred option

“…The total weight of the remnant was intended to be between 2 g and 4 g. Actually, a 1.5-5 g remnant of the thyroid tissue was left behind. The weight of the thyroid remnant was determined by a technique described previously (7). A tissue segment was cut from the resected part of the thyroid, trimmed to the size of the thyroid remnant, and weighed.…”

The Surgical Management of Graves’ Disease

“…If one compares these potential disadvantages and risks to those of radioiodine therapy, one notes that hypothyroidism is a common result of radioactive iodine therapy [31], occurring in 20% of patients in the first year and increasing by 3 to 5% per year thereafter [5]. The risk of hypothyroidism after subtotal thyroidectomy varies depending on the amount of thyroid remnant left behind, but can arise in up to 60% of cases [8,23,[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56]. Thus, the risk of hypothyroidism should not play an important role in the decision making for either treatment for Graves' disease, because hypothyroidism is benign, easily treatable, and almost inevitable in both radioactive iodine therapy and thyroidectomy.…”