Total thyroidectomy as a method of choice in the treatment of Graves’ disease - analysis of 1432 patients

Abstract

BackgroundGraves’ disease represents an autoimmune disease of the thyroid gland where surgery has an important role in its treatment. The aim of our paper was to analyze the results of surgical treatment, the frequency of microcarcinoma and carcinoma, as well as to compare surgical complications in relation to the various types of operations performed for Graves’ disease.MethodsWe analysed 1432 patients (221 male and 1211 female) who underwent surgery for Graves’ disease at the Centre for Endocrine Surgery in Belgrade during 15 years (1996–2010). Average age was 34.8 years. Frequency of surgical complications within the groups was analyzed with nonparametric Fisher’s test.ResultsTotal thyroidectomy (TT) was performed in 974 (68%) patients, and Dunhill operation (D) in 221 (15.4). Carcinoma of thyroid gland was found in 146 patients (10.2%), of which 129 (9%) were a microcarcinoma. Complication rates were higher in the TT group, where there were 31 (3.2%) patients with permanent hypoparathyroidism, 9 (0.9%) patients with unilateral recurrent nerve paralysis and 10 (1.0%) patients with postoperative bleeding. Combined complications, such as permanent hypoparathyroidism with bleeding were more common in the D group where there were 2 patients (0,9%), while unilateral recurrent nerve paralysis with bleeding was more common in the TT group where there were 3 cases (0,3%).ConclusionsFrequency of complications were not significantly statistically different in relation to the type of surgical procedure. Total thyroidectomy represents a safe and efficient method for treating patients with Graves’ disease, and it is not followed by a greater frequency of complications in relation to less extensive procedures.

Comparative analysis of radioactive iodine versus thyroidectomy for definitive treatment of Graves disease

“…In European countries, ATDs tend to be the primary treatment. Surgery or RAI is reserved for cases of recurrence, adverse effects of ATDs, or failure of ATDs 6,9,10,14 ; however, in the United States, RAI tends to be the preferred treatment with operation referral in the presence of potential or confirmed malignancy, in cases of large goiters causing symptomatic compression, with patient preference, or with RAI failure. 1,8 Previous studies have shown evidence for progression of GO after RAI, and current ATA guidelines recommend operation or ATD over RAI in moderate or severe cases.…”

“…Subtotal thyroidectomy had been traditionally preferred over total or near-total thyroidectomy due to concerns of permanent hypothyroidism and possible higher complication rates. 1,5,14 Over the past decade, however, total or near-total thyroidectomy gained favor after multiple studies showing no difference between complications and highlighting the recurrence risks and occurrence of hypothyroidism associated with subtotal resections. 1,8,14,15 …”

Morphological Variations of the Thyroid Gland among the People of Upper Assam Region of Northeast India: A Cadaveric Study

“…Agenesis of isthmus can be diagnosed via scintigraphy, ultrasonography, computed tomography and magnetic resonance imaging. Total or near total thyroidectomy is recommended for patients with ongoing thyroid cancer, those who refuse radio-ablation as a therapeutic procedure, or have a life threatening reaction to antithyroid drugs such as vasculitis, agranulocytosis and liver failure and is the operation of choice for patients undergoing surgical treatment for Grave's disease [22]. Incomplete excision of thyroid gland in patients with auto-immune disorders may cause recurrence of the diseases.…”

Hyperthyroidism

“…108 Total thyroidectomy is recommended, since the frequency of successful outcomes are significantly higher than with subtotal thyroidectomy (odds ratio 40·37, 95% CI 15·03–108·44), 108 with no differences in the rate of complications. 109,110 Thyroidectomy is particularly recommended in patients with the following characteristics: large goitres or low uptake of radioactive iodine (or both); suspected or documented thyroid cancer; moderate-to-severe ophthalmopathy, for which radioactive iodine therapy is contraindicated; and finally, a preference for surgery. 44 Conversely, thyroidectomy should be avoided in patients who are not good surgical candidates.…”