Subtotal Thyroidectomy: A Reliable Method to Achieve Euthyroidism in Graves’ Disease. Prognostic Factors

Moreno, Pablo; Gómez, José Manuel; Gómez, Núria; Francos, José Manuel; Ramos, Emilio; Rafecas, A; Jaurrieta, Eduardo

doi:10.1007/s00268-005-0770-x

Cited by 16 publications

(10 citation statements)

References 37 publications

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“…Therefore, the main indication for surgery in our study was failure of medical treatment. This was also reported by another study with a relatively high rate of postoperative hypothyroidism [16]. Finally, the duration of postoperative followup varied considerably between studies, ranging from several months in some studies to several years in others.…”

Section: Discussionsupporting

confidence: 63%

Thyroid Function after Subtotal Thyroidectomy in Patients with Graves’ Hyperthyroidism

Limonard

Bisschop

Fliers

et al. 2012

The Scientific World Journal

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Background. Subtotal thyroidectomy is a surgical procedure, in which the surgeon leaves a small thyroid remnant in situ to preserve thyroid function, thereby preventing lifelong thyroid hormone supplementation therapy. Aim. To evaluate thyroid function after subtotal thyroidectomy for Graves' hyperthyroidism. Subjects and Methods. We retrospectively reviewed the medical records of all patients (n = 62) who underwent subtotal thyroidectomy for recurrent Graves' hyperthyroidism between 1992 and 2008 in our hospital. Thyroid function was defined according to plasma TSH and free T4 values. Results. Median followup after operation was 54.6 months (range 2.1–204.2 months). Only 6% of patients were euthyroid after surgery. The majority of patients (84%) became hypothyroid, whereas 10% of patients had persistent or recurrent hyperthyroidism. Permanent recurrent laryngeal nerve palsy and permanent hypocalcaemia were noted in 1.6% and 3.2% of patients, respectively. Conclusion. In our series, subtotal thyroidectomy for Graves' hyperthyroidism was associated with a high risk of postoperative hypothyroidism and a smaller, but significant, risk of persistent hyperthyroidism. Our data suggest that subtotal thyroidectomy seems to provide very little advantage over total thyroidectomy in terms of postoperative thyroid function.

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Section: Discussionsupporting

confidence: 63%

Thyroid Function after Subtotal Thyroidectomy in Patients with Graves’ Hyperthyroidism

Limonard

Bisschop

Fliers

et al. 2012

The Scientific World Journal

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show abstract

“…This study investigated the incidence of thyroid failure over time in patients undergoing surgery intended to preserve thyroid function (mainly subtotal thyroidectomy). The prevalence of thyroid failure in this cohort exceeds other prevalence estimates although this may be related to the length of follow-up [5,11,14]. Female patients and those with higher remnant weights demonstrated longer periods of euthyroidism but the majority developed clinical thyroid failure within the first decade.…”

Section: Discussionmentioning

confidence: 52%

“…Subtotal thyroidectomy was the standard treatment for Graves’ disease for most of the twentieth century. This approach aims to restore function and reduce complications by preserving a remnant of thyroid tissue [6,11]. Palit et al [5] reported that subtotal thyroidectomy achieved euthyroidism in 60 percent of patients and supported its use in milder forms of hyperthyroidism.…”

Section: Discussionmentioning

confidence: 99%

“…A myriad of factors including remnant weight, degree of lymphocytic infiltration, and thyroid stimulating hormone receptor, thyroid peroxidase or antithyroglobulin antibodies for their value in predicting function after subtotal thyroidectomy [2,4,9,11,13,14]. Most studies concluded that remnant gland weight is the most consistent risk factor.…”

Section: Discussionmentioning

confidence: 99%

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

Al-Adhami

Snaith

Krukowski

2013

Journal of Otolaryngology - Head & Neck Surgery

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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.

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“…Thyroidectomy is often performed in patients with a large goiter, as a secondary treatment when antithyroid medication fails, in younger patients, and in patients who hope for an immediate remission. There is much controversy as to whether subtotal thyroidectomy or total thyroidectomy should be selected to treat patients with Graves' disease [9][10][11][12][13][14][15]. We think that long-term euthyroidism without medication, not euthyroidism with thyroxin replacement therapy, is the ideal goal and that it can only be achieved by subtotal thyroidectomy.…”

Section: Discussionmentioning

confidence: 99%

Changes in the thyroid function of Graves’ disease patients treated by subtotal thyroidectomy

et al. 2012

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Subtotal Thyroidectomy: A Reliable Method to Achieve Euthyroidism in Graves’ Disease. Prognostic Factors

Cited by 16 publications

References 37 publications

Thyroid Function after Subtotal Thyroidectomy in Patients with Graves’ Hyperthyroidism

Thyroid Function after Subtotal Thyroidectomy in Patients with Graves’ Hyperthyroidism

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

Changes in the thyroid function of Graves’ disease patients treated by subtotal thyroidectomy

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