Background Total thyroidectomy (TT) is the preferred surgical approach to Graves' disease (GD). Current American Thyroid Association (ATA) guidelines call for administration of potassium iodide (KI) and achievement of euthyroid state before operation. Small numbers and a mixture of surgical approaches spanning several decades hinder previous surgical series. We present the outcomes for TT at a single high-volume center. Methods A retrospective cohort study was conducted on 165 patients undergoing TT for GD from 7/2007 to 5/2012. Results Mean age was 43 years (Range: 17-78), and 128 patients (78%) were female. 95% of patients were on methimazole or propylthiouracil, and 42% remained hyperthyroid at time of surgery. Only 3 (2%) patients received KI. Mean operative time was 132 minutes (Range 59-271). Mean gland size and blood loss were 41 grams (Range 8-180) and 55 mL (Range 10-1050), respectively. No patient developed thyroid storm. Median follow-up was 7.5 months. Temporary and permanent hypocalcemia developed in 51 (31%) and two patients (1.2%), respectively. Temporary and permanent recurrent laryngeal nerve paresis occurred in 12 (7%) and one (0.6%) patient, respectively. Sixty-one (37%) patients experienced at least one complication. On multivariate analysis, patient age less than 45 years (OR 2.93, 95% CI 1.39-6.19) and obesity (OR 2.11, 95% CI 1.00-4.43) were associated with occurrence of complications. Conclusion This high-volume surgeon experience demonstrates no appreciable detriment to patient outcomes when ATA recommendations for routine use of KI and euthyroid state before thyroidectomy are not met. Transient hypocalcemia and hoarseness are frequent complications of TT for GD resolving within six months in most patients. Age less than 45 years and obesity are risk factors for post-operative complications.

These data demonstrate a higher than expected incidental cancer rate in TNG patients compared to historical reports (18.3 vs. 3 %). This higher cancer incidence may alter the risk/benefit analysis regarding TNG treatment. This information should be provided to TNG patients before decision making regarding treatment.

Therapeutic study, level IV.