Abstract
One hundred fifty-seven patients with hyperthyroidism treated by subtotal thyroidectomy 2–8 years previously were followed up with serum T3, T4, and TSH determinations. There was some difficulty in distinguishing the various groups of patients by thyroid function tests. However, it was determined that the percentages of patients with hyperthyroidism, euthyroidism, and hypothyroidism, based on T3 values, were 3.2%, 89.7%, and 7.1%, respectively, whereas 5.8%, 41.6%, and 53.1% were hyperthyroid, euthyroid, and hypothyroid by TSH criteria. Subclinical hypothyroidism, that is, increased TSH levels but normal T3 and T4 levels, accounted for the major discrepancy in these results. Subclinical hypothyroidism is more sensitive to disclosure by the TRH stimulation test. However, the incidence and severity of hypothyroidism after thyroidectomy are lower and milder than after131I treatment. The recurrence rate is less than that after the administration of antithyroid drugs, and postoperative complications are rare. Surgical treatment, therefore, plays an important role in the treatment of patients with hyperthyroidism. Those patients with sustained subclinical hypothyroidism after subtotal thyroidectomy should receive supplemental thyroid hormone.
Résumé
Cent cinquante-sept malades présentant une hyperthyroïdie ont subi une thyroïdectomie subtotale 2–8 ans avant d'être soumis à la détermination du taux des T3, T4 et TSH sériques. Il est toujours assez difficile de distinguer les divers groupes de malades en fonction des tests thyroïdiens. Cependant il fut possible dans cette série d'établir que le pourcentage des hyperthyroïdiens, euthyroïdiens et hypothyroïdiens en fonction du taux de T3 était respectivement de 3,2%, 89,7% et 7,1% cependant qu'en fonction de la TSH il était de 5,8%, 41,6% et 53,1%. L'hypothyroïdisme infra-clinique se manifeste par une élévation du taux de TSH mais un taux normal de T3 et T4 est la cause majeure de ces résultats contradictoires. L'hypothyroïdisme infraclinique est donc décelable par le test de stimulation de la TRH. Il est à noter que la fréquence et l'intensité de l'hypothyroïdisme après thyroïdectomie sont plus basses et plus faibles qu'après traitement par l'I131. Le taux de récidive est plus faible que celui secondaire au traitement par des drogues anti-thyroïdiennes et les complications postopératoires sont rares.
En conclusion, la chirurgie garde une place importante dans le traitement de l'hyperthyroïdie. Les opérés qui présentent des manifestations infracliniques d'hypothyroïdisme après thyroïdectomie subtotale doivent bénéficier d'un traitement par l'hormone thyroïdienne.
Resumen
Ciento cincuenta y siete pacientes con hipertiroidismo tratados con tiroidectomía subtotal entre 2 y 8 anos antes, fueron seguidos mediante determinaciones de séricas de T3, T4 y TSH. Hubo cierta dificultad en diferenciar los diversos grupos de pacientes de acuerdo a las pruebas de función tiroidea. Sin embargo, se pudo establecer que los porcentajes de pacientes con hiper, eu e hipotiroidismo, basados en los valores de T3, fueron de 3,2%, 89,7% y 7,1% respectivamente, en tanto que 5,8%, 41,6% y 53,1% aparecieron hiper, eu e hipertiroideos mediante criterios de TSH. El hipotiroidismo subclínico, o sea niveles aumentados de TSH pero con valores normales de T3 y T4, significó la causa mayor de discrepancia en los resultados. El hipotiroidismo subclínico es más susceptible de ser identificado por medio de la prueba de TRH. Sin embargo, la incidencia y severidad del hipotiroidismo que se presenta después de tiroidectomía son menores y más leves que en el que ocurre después del tratamiento con I131. El tratamiento quirúrgico, por consiguiente, juega un papel importante en el manejo de pacientes con hipertiroidismo. La integración de los datos presentados en este estudio señala que la tiroidectomía subtotal es todavía el tratamiento de elección en pacientes tirotóxicos. Aquellos pacientes que desarrollan hipotiroidismo subclínico persistente después de tiroidectomía subtotal deben recibir hormona tiroidea suplementaria.
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Harada, T., Shimaoka, K., Arita, S. et al. Follow-up evaluation of thyroid function after thyroidectomy for thyrotoxicosis. World J. Surg. 8, 436–443 (1984). https://doi.org/10.1007/BF01654907
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DOI: https://doi.org/10.1007/BF01654907