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Near total thyroidectomy is an optimal treatment for graves’ disease

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Abstract

Surgical management of Graves’ disease is still debated. We report our current experience with thyroidectomy for Graves’ disease at a tertiary center. A retrospective database of 132 patients who underwent surgery for Graves’ disease from January 1985 to December 2008 was collected. During that period, 16 patients underwent subtotal thyroidectomy and 116 patients underwent near total thyroidectomy. Eighty-seven patients (66%) underwent surgery for recurrent disease after medical therapy. Forty-five patients (34%) had surgery as a primary treatment, the indications were large goiter size in 22 (17%), patient preference in 19 (14%), and associated cold nodule in 3 (2%). The incidence of cancer was 4.4%. Permanent hypoparathyroidism was observed in one patient who underwent a second surgery for recurrence. Unilateral transitory vocal cord palsy was observed in nine patients (7%), bilateral transitory vocal cord palsy was observed in one patient, and no definitive vocal cord palsy was observed. Two patients (1.5%) experienced post-operative hemorrhagia requiring surgical revision. Near total thyroidectomy for Graves’ disease provides an immediate and definitive treatment with a low complication rate. Near total thyroidectomy offers an appropriate treatment for coexisting malignancy. This procedure can be safely recommended as a primary treatment, in experienced hands.

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References

  1. Reid JR, Wheeler SF (2005) Hyperthyroidism: diagnosis and treatment. Am Fam Physician 72(4):623–630

    PubMed  Google Scholar 

  2. Kaplan MM, Meier DA, Dworkin HJ (1998) Treatment of hyperthyroidism with radioactive iodine. Endocrinol Metab Clin North Am 27(1):205–223

    Article  CAS  PubMed  Google Scholar 

  3. Pradeep PV, Agarwal A, Baxi M et al (2007) Safety and efficacy of surgical management of hyperthyroidism: 15-year experience from a tertiary care center in a developing country. World J Surg 31(2):306–312 discussion 313

    Article  CAS  PubMed  Google Scholar 

  4. Witte J, Goretzki PE, Dotzenrath C et al (2000) Surgery for Graves’ disease: total versus subtotal thyroidectomy-results of a prospective randomized trial. World J Surg 24(11):1303–1311

    Article  CAS  PubMed  Google Scholar 

  5. Chang DC, Wheeler MH, Woodcock JP et al (1987) The effect of preoperative Lugol’s iodine on thyroid blood flow in patients with Graves’ hyperthyroidism. Surgery 102(6):1055–1061

    CAS  PubMed  Google Scholar 

  6. Lahey FH (1949) Technic of subtotal thyroidectomy. Surg Clin North Am 29(3):641–658

    CAS  PubMed  Google Scholar 

  7. Glinoer D, Hesch RD, Lagasse R, Laurberg P (1987) The management of hyperthyroidism due to Graves’ disease in Europe in 1986: results of an international survey. Acta Endocrinol 115:1–23

    Google Scholar 

  8. Weetman AP (2000) Graves’ disease. N Engl J Med 343(17):1236–1248

    Article  CAS  PubMed  Google Scholar 

  9. Tallstedt L, Lundell G, Torring O et al (1992) Occurrence of ophthalmopathy after treatment for Graves’ hyperthyroidism. The Thyroid Study Group. N Engl J Med 326(26):1733–1738

    Article  CAS  PubMed  Google Scholar 

  10. Glinoer D, De Nayer P, Bex M (2001) Effects of thyroxine administration, thyrotropin-receptor antibodies and smoking on the risk of recurrence in Graves’ hyperthyroidism treated with antithyroid drugs: a double blind prospective randomized study. Eur J Endocrinol 144:475–483

    Article  CAS  PubMed  Google Scholar 

  11. Abraham-Nordling M, Torring O, Hamberger B et al (2005) Graves’ disease: a long-term quality-of-life follow up of patients randomized to treatment with antithyroid drugs, radioiodine, or surgery. Thyroid 15(11):1279–1286

    Article  CAS  PubMed  Google Scholar 

  12. Werga-Kjellman P, Zedenius J, Tallstedt L, Träisk F, Lundell G, Wallin G (2001) Surgical treatment of hyperthyroidism: a ten-year experience. Thyroid 11(2):187–192

    Article  CAS  PubMed  Google Scholar 

  13. Miccoli P, Vitti P, Rago T, Iacconi P, Bartalena L, Bogazzi F, Fiore E, Valeriano R, Chiovato L, Rocchi R, Pinchera A (1996) Surgical treatment of Graves’ disease: subtotal or total thyroidectomy? Surgery 120:1020–1025

    Article  CAS  PubMed  Google Scholar 

  14. Weber KJ, Solorzano CC, Lee JK et al (2006) Thyroidectomy remains an effective treatment option for Graves’ disease. Am J Surg 191(3):400–405

    Article  PubMed  Google Scholar 

  15. Barakate MS, Agarwal G, Reeve TS et al (2002) Total thyroidectomy is now the preferred option for the surgical management of Graves’ disease. ANZ J Surg 72(5):321–324

    Article  PubMed  Google Scholar 

  16. Palit TK, Miller CC 3rd, Miltenburg DM (2000) The efficacy of thyroidectomy for Graves’ disease: a meta-analysis. J Surg Res 90(2):161–165

    Article  CAS  PubMed  Google Scholar 

  17. Sugino K, Ito K, Nagahama M et al (2008) Surgical management of Graves’ disease—10-year prospective trial at a single institution. Endocr J 55(1):161–167

    Article  PubMed  Google Scholar 

  18. Ku CF, Lo CY, Chan WF et al (2005) Total thyroidectomy replaces subtotal thyroidectomy as the preferred surgical treatment for Graves’ disease. ANZ J Surg 75(7):528–531

    Article  PubMed  Google Scholar 

  19. Eckstein AK, Plicht M, Lax H et al (2006) Thyrotropin receptor autoantibodies are independent risk factors for Graves’ ophthalmopathy and help to predict severity and outcome of the disease. J Clin Endocrinol Metab 91(9):3464–3470

    Article  CAS  PubMed  Google Scholar 

  20. Torring O, Tallstedt L, Wallin G et al (1996) Graves’ hyperthyroidism: treatment with antithyroid drugs, surgery, or radioiodine—a prospective, randomized study. Thyroid Study Group. J Clin Endocrinol Metab 81(8):2986–2993

    Article  CAS  PubMed  Google Scholar 

  21. Bartalena L, Marcocci C, Bogazzi F et al (1998) Relation between therapy for hyperthyroidism and the course of Graves’ ophthalmopathy. N Engl J Med 338(2):73–78

    Article  CAS  PubMed  Google Scholar 

  22. Kurihara H (2002) Total thyroidectomy for the treatment of hyperthyroidism in patients with ophthalmopathy. Thyroid 12(3):265–267

    Article  PubMed  Google Scholar 

  23. Acharya S, Avenell A, Philip S, Burr J, Bevan J, Abraham P (2008) Radioiodine therapy (RAI) for Graves’ disease (GD) and the effect on ophthalmopathy: a systematic review. Clin Endocrinol 69:943–950

    Article  Google Scholar 

  24. Stalberg P, Svensson A, Hessman O et al (2008) Surgical treatment of Graves’ disease: evidence-based approach. World J Surg 32(7):1269–1277

    Article  PubMed  Google Scholar 

  25. Ain KB (1995) Papillary thyroid carcinoma. Etiology, assessment, and therapy. Endocrinol Metab Clin North Am 24(4):711–760

    CAS  PubMed  Google Scholar 

  26. Pellegriti G, Belfiore A, Giuffrida D et al (1998) Outcome of differentiated thyroid cancer in Graves’ patients. J Clin Endocrinol Metab 83(8):2805–2809

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This study was supported by «les amis de l’institut bordet».

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There is no financial relationship with the organization that sponsored the research.

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Correspondence to Antoine Digonnet.

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Digonnet, A., Willemse, E., Dekeyser, C. et al. Near total thyroidectomy is an optimal treatment for graves’ disease. Eur Arch Otorhinolaryngol 267, 955–960 (2010). https://doi.org/10.1007/s00405-009-1174-6

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  • DOI: https://doi.org/10.1007/s00405-009-1174-6

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