Graves's Disease and Total Thyroidectomy

Werner, Sidney C.; Feind, Carl R.; Aida, Mitsuyasu

doi:10.1056/nejm196701192760302

Cited by 61 publications

(8 citation statements)

References 16 publications

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“…Similar conclusions were drawn by Marcocci and collegues (18) in a case control study of near-total thyroidectomy in a limited number of patients with nonsevere ophthalmopathy (18). Werner and associates (19) even reported that total thyroidectomy could worsen the eye symptoms.…”

Section: Discussionsupporting

confidence: 72%

Graves' Disease with Moderate–Severe Endocrine Ophthalmopathy–Long Term Results of a Prospective, Randomized Study of Total or Subtotal Thyroid Resection

Järhult¹,

Rudberg

Larsson

et al. 2005

Thyroid

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The optimal thyroid surgery to be performed in patients with Graves' disease and concomitant endocrine ophthalmopathy is a matter of debate. We randomly assigned 44 patients with moderate-severe eye signs in a trial of treatment with subtotal, leaving a small (approximately 2 g) thyroid remnant, or total thyroidectomy. At inclusion, the patients had been treated with antithyroid drugs, and corticosteroids been given to 12 (27%). All received postoperative thyroxine supplementation and were followed for 3 years at regular examinations. The eye disease improved in all cases, and throughout the study, the two groups did not differ with regard to subjective and objective eye symptoms and laboratory findings. At the study start, motility disturbances were present in 8 and 11 of the cases in the subtotal and total resection group and proptosis in 16 and 17, respectively. After 3 years, the corresponding data were 3 and 6 cases with motility defects and 16 and 15 cases with proptosis. Thyrotropin (TSH)-receptor antibody levels gradually fell and became nondetectable in 21 (49%). The surgical complication rate (permanent recurrent laryngeal nerve paresis and permanent hypoparathyroidism) was significantly higher in the total thyroidectomy group. The data indicate that in patients with Graves' disease and active endocrine ophthalmopathy, subtotal thyroidectomy, leaving a small thyroid remnant, will reduce the risk of surgical complications but not the beneficial effect of surgery.

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Section: Discussionsupporting

confidence: 72%

Graves' Disease with Moderate–Severe Endocrine Ophthalmopathy–Long Term Results of a Prospective, Randomized Study of Total or Subtotal Thyroid Resection

Järhult¹,

Rudberg

Larsson

et al. 2005

Thyroid

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“…In recent years many retrospective studies have compared the effect of endocrine drugs, radioiodine, and thyroid surgery on changes in GO; more favorable results were seen after surgery than after radioiodine treatment [1,5,14,26,27]. This stands in contrast to reports of worsening eye symptoms after total thyroidectomy by Werner et al [15] and after subtotal thyroidectomy by Catz and Perzik [16]; and it questions whether thyroid surgery has a direct effect on additional immunologic side effects of Graves' disease, such as GO.…”

Section: Discussionmentioning

confidence: 99%

“…In comparison to radioiodine treatment, the number of operated patients has decreased in recent years; and surgery is indicated mainly in patients of young age, pregnant women with Graves' disease and patients with goiters larger than 60 ml [1][2][3][4][5][6][7]. Some authors also recommend surgery for patients with troublesome endocrine orbitopathy (GO) [1, 3-5, 8 -10], where radioiodine treatment does not seem to have a positive effect [11][12][13][14][15]. The present data on GO after various therapeutic modalities have been accumulated mainly from retrospective analyses questioning the clinical value of these studies [1,5,8,10,13,15,16].…”

mentioning

confidence: 99%

“…Some authors also recommend surgery for patients with troublesome endocrine orbitopathy (GO) [1, 3-5, 8 -10], where radioiodine treatment does not seem to have a positive effect [11][12][13][14][15]. The present data on GO after various therapeutic modalities have been accumulated mainly from retrospective analyses questioning the clinical value of these studies [1,5,8,10,13,15,16]. Thus only scanty information exists about the importance of remnant size on postoperative GO changes and on changes in postoperative thyrotropin receptor antibody (TSH-R-Ab) titers [17].…”

mentioning

confidence: 99%

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Surgery for Graves' Disease: Total versus Subtotal Thyroidectomy—Results of a Prospective Randomized Trial

et al. 2000

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The effect of surgery on Graves' orbitopathy (GO) is still controversial. Retrospective analyses of many authors (including our own group) demonstrated GO improvement after subtotal thyroid resection in up to 70% of operated patients, so the question arose whether total thyroidectomy could add anything to this pronounced positive effect on GO. We therefore performed a prospective randomized trial on 150 patients with Graves' disease (125 women, 25 men; mean thyroid volume 80.5 ml) comparing three surgical procedures (bilateral subtotal thyroid resection-total remnant < 4 ml; unilateral hemithyroidectomy with contralateral subtotal thyroid resection-remnant < 4 ml; total thyroidectomy) and their effect on postoperative GO changes, postoperative thyroid-stimulating hormone receptor (TSH-R) antibody titers, and postoperative complication rates. After a period of at least 6 months (6-36 months) GO had improved in 71% to 74% of all patients regardless of whether total or subtotal thyroidectomy was performed. TSH-R antibody titers showed no differences for the three surgical groups. Postoperative recurrent hyperthyroidism occurred in two patients with subtotal resections, and early postoperative hypoparathyroidism was more frequently detected in patients with total thyroidectomy than in those with subtotal thyroid resection (28% vs. 12%; p < 0.002). In respect to possible postoperative hypoparathyroidism and a lack of difference in postoperative GO changes, we do not advocate total thyroidectomy for patients with Graves' disease and Graves' orbitopathy but prefer radical subtotal thyroid resection with a remnant of less than 4 ml.

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“…Recurrences may be troublesome to manage, especially in patients with histories of endocrine ophthalmopathy (EO), because the immunological activation at recurrency may concomitantly aggravate the eye involvement (6,7). Provided that this activation is thyroid-tissue depend¬ ent, the reported variable influences of thyroid resection on EO and therapy-resistant GD (8)(9)(10)(11)(12)(13) may be improved hypothetically by more radical operative procedures.…”

mentioning

confidence: 99%

Retrospective evaluation of subtotal and total thyroidectomy in Graves' disease with and without endocrine ophthalmopathy

Winsa

Rastad

Åkerström

et al. 1995

European Journal of Endocrinology

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A retrospective analysis was performed in 173 consecutive patients with Graves' disease (GD) with the principal aim of evaluating the influences of subtotal (N = 157) and total (N = 19) thyroidectomy on postoperative recurrence rates, endocrine ophthalmopathy (EO) and thyrotropin receptor antibody (TSH-R-ab) titres. Postoperatively recurrent disease, identified by increased thyroid hormone levels, occurred in 32 patients (20%) who underwent subtotal resection. These recurrences were associated with over-representation of preoperative EO (p < 0.001) as well as high TSH-R-ab levels postoperatively (p < 0.05-0.01). Subtotal and total resections were followed by an aggravation of preoperative EO in nine (16%) and one (6%), and by a development of EO in two and none of the patients, respectively. Persistently elevated TSH-R-ab titers during thyrostatic therapy became close to normalized in seven (32%) and 15 (88%) of the patients undergoing subtotal or total thyroidectomies, respectively, which illustrates a thyroid tissue dependency of the autoantibody production. Among the total material of 173 patients, altogether 75 cases exhibited persistent or progressive EO and/or TSH-R-ab elevation after more than 1 year of preoperative thyrostatic treatment. In this group, recurrent GD or aggravated EO occurred in 23 (39%) of those operated with subtotal resection and in one (6%) of those undergoing total thyroidectomy (p < 0.05). The results thus indicate that EO, particularly at the time of surgery, and prevailing TSH-R-ab titers are associated with an increased risk of recurrent GD and suggest that patients exhibiting these characteristics should benefit from total rather than subtotal thyroidectomy.

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Graves's Disease and Total Thyroidectomy

Cited by 61 publications

References 16 publications

Graves' Disease with Moderate–Severe Endocrine Ophthalmopathy–Long Term Results of a Prospective, Randomized Study of Total or Subtotal Thyroid Resection

Graves' Disease with Moderate–Severe Endocrine Ophthalmopathy–Long Term Results of a Prospective, Randomized Study of Total or Subtotal Thyroid Resection

Surgery for Graves' Disease: Total versus Subtotal Thyroidectomy—Results of a Prospective Randomized Trial

Retrospective evaluation of subtotal and total thyroidectomy in Graves' disease with and without endocrine ophthalmopathy

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