Changing trends in surgery for Graves’ disease: A cohort comparison of those having surgery intended to preserve thyroid function with those having ablative surgery

Abstract

BackgroundSurgery for Graves’ disease may be performed with the intent of preserving thyroid function (subtotal thyroidectomy) or ablating thyroid function (total thyroidectomy). This study examines the evolving practice in a specialist endocrine surgical unit.MethodLongitudinal cohort study of patients undergoing surgery for Graves’ disease between 1986 and 2008. Outcome measures were thyroid failure, recurrent toxicity, recurrent laryngeal nerve (RLN) palsy, early reoperation and hypocalcaemia. Time to thyroid failure was analysed by potential predictors.ResultsOf 149 patients (129 female), 78 (52.3 percent) underwent subtotal thyroidectomy with the intention to preserve function (PF) and 71 (47.6 percent) total thyroidectomy with the intention to ablate thyroid function (AF). Mean duration of follow-up was 11.1 years; 14.8 years and 7.0 years respectively. Of 78 PF procedures: six (7.7 percent) patients suffered recurrent toxicity; 68 (87.2 percent) developed thyroid failure (four after treatment for recurrent toxicity); and eight (10 percent) remained euthyroid without replacement. Male gender and remnant gland weight were significant predictors of failure (P = 0.021 and 0.022 respectively). One patient developed permanent RLN palsy and one permanent hypocalcaemia. Of 71 AF procedures: one developed acute airway obstruction; one permanent RLN palsy; four permanent hypocalcaemia; and none developed recurrent toxicity. There were no deaths within a year of surgery. There was no statistically significant difference in complication rates.ConclusionMost PF resections resulted in eventual thyroid failure. The shift to ablative surgery virtually eliminated the need for lifelong specialist follow-up, albeit with an insignificant rise in permanent hypocalcaemia.

Assessment of Thyroidectomies in Children at the ENT Department of the Thiès Regional Hospital, about 29 Cases over 16 Years (2003-2018)

“…Our results are lower than those of Al-Adhami [5] and Chen [6], who found a mean age of 14.3 ± 1.9 years and 15.4 years respectively. Our results corroborate those of Akkari et al [4], who noted in their study a mean age of 12.5 ± 0.7 years, with extremes of 13 months and 18 years.…”

Partial Versus Total Thyroidectomy

“…3 They found an overall benefit of total thyroidectomy over partial thyroidectomy because of the lower rate of completion total thyroidectomy due to incidental cancer and goiter recurrence without an increase in the complication rate. Similar conclusions were drawn for Grave disease 12 and for thyroid cancer. 4 More recently, this drastic attitude has become more and more nuanced, with an increasing trend toward weighting the risk benefits ratio for each intervention and for each patient rather than systematically promoting radical thyroidectomy.…”

A Study on Surgical Management of Thyrotoxicosis

“…There were nil deaths within a year of surgery and ablative surgery eliminated the need for lifelong specialist follow-up, with an insignificant rise in permanent hypocalcaemia. 8 Postoperative complications like four% permanent recurrent laryngeal nerve palsy, nine% hematoma requiring surgical revision, and three% definitive hypocalcaemia. Postoperative complications were more frequent in multinodular goiter than in Graves' disease.…”