Thyroid Function after Subtotal Thyroidectomy in Patients with Graves’ Hyperthyroidism

Abstract

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.

Chemically or surgically induced thyroid dysfunction altered gut microbiota in rat models

“…The other major concern in our study is the recovery of T4 level in SHO group at 7 weeks of follow up. As already mentioned, during the surgical procedure, a small thyroid remnant was left in situ in this group to preserve thyroid functions, 26 thereby avoiding thyroid hormone supplementation in the animals for sustaining their lives. Previous studies have shown that adult thyroid contains a population of cells with stem properties that appears to be activated upon tissue regeneration following partial thyroidectomy 45‐47 .…”

“…To develop nonchemical‐induced hypothyroidism, subtotal thyroidectomy was performed in the rats (SHO group). In this surgical procedure, almost the entire thyroid gland was removed from the animals, leaving only a small thyroid remnant in situ to preserve thyroid functions, 26 thereby preventing from thyroid hormone supplementation therapy for sustaining their lives. Anesthesia was induced by intramuscular injection with Zoletil (tiletamine‐zolazepam, Virbac Laboratories, Carros, France) and Rompun (xylazine‐hydrochloride, Bayer, Leverkusen, Germany) in combination (1:1. v/v).…”

Short-Term Outcomes of Surgery for Graves’ Disease in Germany

“…Total thyroidectomy is regarded as an effective treatment of GD with definitive control of hyperthyroidism and its symptoms [ 5 , 29 ]. Subtotal resection for GD is considered as surgical strategy with a lower rate of postoperative hypoparathyroidism, but a higher risk of persistence or recurrence of disease [ 30 , 31 ]. Five RCTs since the 90 s with a total of 879 patients deal with the extent of thyroid resection for sufficient treatment of GD regarding postoperative complications [ 11 , 12 , 13 , 14 , 32 ].…”

Degree of technical difficulty of thyroidectomy for autoimmune thyroid disease

“…Performing a total thyroidectomy in both HT and GD may have significant benefits. For example, GD has been shown to have to significantly lower recurrence rates with total thyroidectomy . Patients with HT may benefit from improved symptom relief as well as decreased potential of malignancy.…”