Hypothyroidism after thyroidectomy for Graves' disease

Farnell, Michael B.; Heerden, Jonathan A. van; McConahey, William M.; Carpenter, Herschel A.; Wolff, Luther H.

doi:10.1016/0002-9610(81)90419-0

Cited by 32 publications

(19 citation statements)

References 18 publications

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“…Postoperative hy¬ pothyroidism is common during the first postoperative year, ranging from 5%-75% (23,(27)(28)(29) and was 16.8% at 3 months in this series, but the rate of hypothyroidism was much less later in the follow-up period (8.0%). Postoperative hy¬ pothyroidism is common during the first postoperative year, ranging from 5%-75% (23,(27)(28)(29) and was 16.8% at 3 months in this series, but the rate of hypothyroidism was much less later in the follow-up period (8.0%).…”

Section: Discussionmentioning

confidence: 48%

Results of Subtotal Thyroidectomy for Graves' Disease

Chou¹,

Wang²,

Huang³

1999

Thyroid

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The objective of this study was to find the factors responsible for hypothyroidism after subtotal thyroidectomy for Graves' disease. Two hundred five patients who were operated on from July 1989 to December 1997 were studied. The mean age of patients was 33.4+/-11.0 (mean +/- SD) years, and 175 (85.4%) were female. Patients were prepared with an antithyroid drug and Lugol's solution preoperatively. Triiodothyronine (T3), thyroxine (T4), thyrotropin (TSH), thyrotropin-binding immunoglobulins (TBII) antimicrosomal antibodies (AMA = 100x 4(M-1)), and antithyroglobulin antibodies (ATA = 100x4(T-1)) were measured 1 week before patients were operated on. Operations were performed according to the standard procedure with 2.5x1x1 cm of thyroid tissue remaining on each side before approximating the thyroid capsule and pretracheal fascia. Hypothyroidism was defined by patients with overt hypothyroidism in laboratory data, and or with T4 to maintain T3 and T4. Two hundred two patients were checked 3 months after being operated on. Latent hyperthyroidism was found in 22, euthyroidism in 55, latent hypothyroidism in 91, hypothyroidism in 34 (16.8%) and none were in overt hyperthyroidism. After a follow-up period of 26.9+/-15 (mean +/- SD) months, 199 patients were reevaluated. Overt hyperthyroidism was found in 2 patients, latent hyperthyroidism in 12, euthyroidism in 97, latent hypothyroidism in 72, and hypothyroidism in 16 (8%). Factors having possible effects on hypothyroidism after longterm follow-up were analyzed. Patient's age, gender, body surface, premedicative T3 and T4, preoperative ATA, and TBII, and the weight of removed thyroid had no effect on the occurrence of hypothyroidism. Preoperative AMA levels, and finding more than 10 lymphoid infiltrations per 10 low-power fields (x40) were significantly different between the hypothyroid and nonhypothyroid groups. A high level of preoperative AMA was the only factor independently causing overt hypothyroidism in the follow-up period. Patients with high preoperative AMA levels have a higher risk of hypothyroidism if only 2.5x1x1 cm remnants are left on each side.

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Section: Discussionmentioning

confidence: 48%

Results of Subtotal Thyroidectomy for Graves' Disease

Chou¹,

Wang²,

Huang³

1999

Thyroid

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“…The incidence is similar in both treatment modalities and is reported to be up to 9.8% after surgery [8,45,47,[52][53][54][55][56][57]. The amount of thyroid remnant remaining after thyroidectomy is positively correlated to the incidence of recurrent hyperthyroidism, [45] although not all studies have found this association, likely because of the difficulty of accurate measurements.…”

Section: Comparison Between Treatmentsmentioning

confidence: 90%

“…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.…”

Section: Comparison Between Treatmentsmentioning

confidence: 99%

The Surgical Management of Graves’ Disease

Schussler-Fiorenza

Bruns

Chen

2006

Journal of Surgical Research

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“…Dem stehen vor allem entgegen die, insbesondere bei der Radiojodtherapie fehlende, therapiebedingte Morbidit/it. Wie die Radiojodtherapie beinhaltet die operative Behandlung jedoch dariiber hinaus eine unterschiedliche Rate an Schilddriisenfunktionsst6rungen, die allerdings nicht nur Folge der Art und Intensit/it der Schilddriisenablation sind [11,17,37], sondern wahrscheinlich auch durch die aliment/ire Jodversorgung [54] und die Intensit/it des Autoimmunprozesses im Restgewebe [6,19,20,28,32,57] beeinflul3t werden.…”

Section: Surgical Treatment Of Graves' Diseaseunclassified

Operatives Therapiekonzept der Immunthyreopathie

Dralle

Schober

Hesch

1987

Langenbecks Arch Chiv

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73 patients with Graves' disease, surgically treated from 1975-1986, were investigated retrospectively. 43 patients, treated by subtotal thyroidectomy (Enderlen-Hotz) and a bilateral thyroid remnant of a total of about 8-12 g, were compared with 30 patients, treated by a modified subtotal thyroidectomy leaving a unilateral thyroid remnant of about 4-8 g, with respect to preoperative duration of disease, indications for surgical treatment, weight of resected specimens, operative complications and postoperative thyroid function. Surgical complications were similar in both groups. After subtotal thyroidectomy 14/43 patients (33%) displayed either recurrent hyperthyroidism (9/43, 21%) or local recurrence of Graves' goiter (3/43, 7%) or both (2/43, 5%). The modified subtotal resected group showed no recurrences of the disease. After subtotal thyroidectomy 11 patients were euthyroid without thyroid medication (26%) compared to only two patients (7%) after the modified procedure of subtotal thyroid resection. To prevent recurrences of goiter as well as hyperthyroidism and, on the other hand, to achieve euthyroid function postoperatively without need for thyroid replacement therapy, subtotal thyroidectomy with a small thyroid remnant of about 4-8 g is recommended for all patients with large goiter and a chronic recurrent course of the disease or with iodine induced thyrotoxicosis. Patients with non-recurrent Graves' disease but large goiter probably benefit from subtotal thyroidectomy with a larger thyroid remnant of about 8-12 g.

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Hypothyroidism after thyroidectomy for Graves' disease

Cited by 32 publications

References 18 publications

Results of Subtotal Thyroidectomy for Graves' Disease

Results of Subtotal Thyroidectomy for Graves' Disease

The Surgical Management of Graves’ Disease

Operatives Therapiekonzept der Immunthyreopathie

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