Skip to main content
SpringerLink
Log in

Early recurrence of hyperthyroidism in patients with Graves' disease treated by subtotal thyroidectomy

  • Original Scientific Reports
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Prerequistes for surgical treatment of Graves' disease are that it can be done safely and that it is associated with a low incidence of recurrent hyperthyroidism. Early recurrence is especially undesirable. We studied 728 patients with Graves' disease treated by subtotal thyroidectomy using multivariate analysis in order to determine the factors related to early recurrence. The following factors were analyzed: age, sex, duration of medical treatment, weight of resected thyroid tissue, thyroid remnant size, preoperative level of thyroid-stimulating hormone (TSH) binding inhibitory immunoglobulin (TBII), and antimicrosomal hemagglutination antibody (MCHA). “Early recurrence” was defined as TSH suppression observed within the first year after surgery and continuing for at least 6 months. A total of 106 patients (14.6%) had early recurrence. Statistical analyses were performed by the chi-square test for univariate analysis and a logistic model for multivariate analysis. Significant factors were thyroid remnant size, MCHA, and TBII. These results indicated that TBII and MCHA are related to early recurrence of hyperthyroidism, and smaller remnant size is recommended for patients with a high MCHA titer or a high TBII level (or both) in order to avoid early recurrence.

Résumé

Le traitement chirurgical de la Maladie de Basedow se doit d'être non seulement sûr mais doit aussi éviter un taux excessif de récidive d'hyperthyroïdie. La récidive précoce est particulièrement fâcheuse. Nous avons étudié 728 patients atteints de Maladie de Basedow, traités par thyroïdectomie subtotale, en analyse multifactorielle, de façon à détecter les facteurs éventuels de récidive précoce. On a analysé les facteurs suivants: âge, sexe, durée du traitement médical, le poids del la pièce réséquée, la taille du moignon restant, les niveaux préopératoires de TSH binding inhibitory immunoglobuline (TBII) et des anticorps antimicrosomial hemagglutination (MCHA). On a utilisé le test Chi2 en analyse monofactorielle et, par modèle logistique, pour l'analyse multifactorielle. La récidive précoce a été définie par l'existence d'une suppression de la TSH observée pendant la première année après la chirugie et durant au moins 6 mois. Cent six patients (14.67%) ont eu une récidive précoce. Les facteurs significatifs étaient la taille du moignon, le MCHA et 1 TBII. Ces résultats indiquent que TBII et MCHA sont des facteurs de récidive précoce. Chez le patient ayant des taux élevés de TBII et MCHA, il vaut mieux réduire d'avantage la taille du moignon pour éviter les risques de récidive précoce.

Resumen

Un prerrequisito para el tratamiento quirúrgico de la enfermedad de Graves es que pueda ser realizado no sólo con seguridad sino también con una baja incidencia de hipertiroidismo recurrente. La recurrencia temprana es especialmente indeseable. Hemos estudiado 728 pacientes con enfermedad de Graves tratados mediante tiroidectomía subtotal utilizando análisis multivariable con miras a identificar los factores que se relacionan con recurrencia temprana. Los siguientes factores fueron analizados: edad, sexo, duración del tratmiento médico, peso del tejido tiroideo resecado, tamaño del remanente tiroideo, nivel sérico preoperatorio de inmunoglobulina inhibidora de la ligadura de TSH (TBII) y de anticuerpo antimicrosomal de hemaglutinación MCHA). Se definió la “recurrencia temprana” como la supresión de TSH que ocurre en el curso del primer año luego de la cirugía y que se continúa por lo menos por 6 meses. Ciento seis pacientes, 14.6%, presentaron recurrencia temprana. El análisis estadístico demostró que el remanente de tiroides, el MCHA y la TBII fucron los factores de significación. Estos resultados indican que la TBII y el MCHA están relacionados con el fenómeno de la recurrencia temprana del hipertiroidismo y por ello se recomienda, para evitar tal recurrencia, un remanente tiroideo menor en los pacientes con MCHA elevada y/o nivel elevado de TBII.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Feliciano, D.V.: Everything you wanted top know about Graves' disease. Am. J. Surg. 164: 404, 1992

    Google Scholar 

  2. Sugino, K., Mimura, T., Toshima, K., et al.: Follow-up evaluation of patients with Graves' disease treated by subtotal thyroidectomy and risk factor analysis for postoperative thyroid dysfunction. J. Endocrinol. Invest. 16: 195, 1993

    Google Scholar 

  3. Menegaux, F., Ruprecht, T., Chigot, J.P.: The surgical treatment of Graves' disease. Surg. Gynecol. Obstet. 176: 277, 1993

    Google Scholar 

  4. Okamoto, T., Fujimoto, Y., Obara, T., Ito, Y., Aiba, M.: Retrospective analysis of prognostic factors affecting the thyroid functional status after subtotal thyroidectomy for Graves' disease. World J. Surg. 16: 690, 1992

    Google Scholar 

  5. Kasuga, Y., Sugenoya, A., Kobayashi, S., et al.: Clinical evaluation of the response to surgical treatment of Graves' disease. Surg. Gynecol. Obstet. 170: 327, 1990

    Google Scholar 

  6. Ozoux, J.P., de Calan, L., Portier, G., et al.: Surgical treatment of Graves' disease. Am. J. Surg. 156: 177, 1988

    Google Scholar 

  7. Busnardo, B., Girelli, M.E., Rubello, D., Eccher, C., Betterle, C.: Long term thyroid function after subtotal thyroidectomy for Graves' disease. J. Endocrinol. Invest. 11: 371, 1988

    Google Scholar 

  8. Jörtsö, E., Lennquist, S., Lundström, B., Norrby, K., Smeds, S.: The influence of remnant size, antithyroid antibodies, thyroid morphology, and lymphocyte infiltration of thyroid function after subtotal resection for hyperthyroidism. World J. Surg. 11: 365, 1987

    Google Scholar 

  9. Cusick, E.L., Krukowski, Z.H., Matheson, N.A.: Outcome of surgery for Graves' disease re-examined. Br. J. Surg. 74: 780, 1987

    Google Scholar 

  10. Harada, T., Shimaoka, K., Arita, S., Nakanishi, Y.: Follow-up evaluation of thyroid function after thyroidectomy for thyrotoxicosis. World J. Surg. 8: 436, 1984

    Google Scholar 

  11. Sugrue, D.D., Drury, M.I., McEvoy, M., Heffernan, S.J., O'Malley, E.: Long term follow-up of hyperthyroid patients treated by subtotal thyroidectomy. Br. J. Surg. 70: 408, 1983

    Google Scholar 

  12. Solomon, B., Glinoer, D., Lagasse, R., Wartofsky, L.: Current trends in the management of Graves' disease. J. Clin. Endocrinol. Metab. 70: 1518, 1990

    Google Scholar 

  13. Nagayama, Y., Izumi, M., Nagataki, S.: The management of hyperthyroidism due to Graves' disease in Japan in 1988. Endocrinol. Jpn. 36: 299, 1989

    Google Scholar 

  14. Glinoer, D., Hesch, D., Lágasse, R., Laurberg, P.: The management of hyperthyroidism due to Graves' disease in Europe in 1986: results of an international survey. Acta Endocrinol. Suppl. (Copenh.), 115: 1, 1987

    Google Scholar 

  15. Nicoloff, J.T., Spencer, C.A.: The use and misuse of the sensitive thyrotropin assays. J. Clin. Endocrinol. Metab. 71: 553, 1990

    Google Scholar 

  16. Spencer, C.A., LoPresti, J.S., Patel, A., et al.: Application of a new chemiluminometric thyrotropin assay to subnormal measurement. J. Clin. Endocrinol. Metab. 70: 453, 1990

    Google Scholar 

  17. Spencer, C.A.: Clinical utility and cost-effectiveness of sensitive thyrotropin assays in ambulatory and hospitalized patients. Mayo Clin. Proc. 63: 1214, 1988

    Google Scholar 

  18. Hopton, M.R., Harrop, J.S.: Immunoradiometric assay of thyrotropin as a “first-line” thyroid function test in the routine laboratory. Clin. Chem. 32: 691, 1986

    Google Scholar 

  19. Mori, Y., Matoba, Y., Miura, S., Sakai, N., Taira, Y.: Clinical course and thyroid stimulating hormone (TSH) receptor antibodies during surgical treatment of Graves' disease. World J. Surg. 16: 647, 1992

    Google Scholar 

  20. Steel, N.R., Taylor, J.J., Young, E.T., Farndon, J.R., Holcombe, M., Kendall-Taylor, P.: The effect of subtotal thyroidectomy with propronolol preparation on antibody activity in Graves' disease. Clin. Endocrinol. (Oxf.) 26: 97, 1987

    Google Scholar 

  21. Hamada, N., Ito, K., Mimura, T., et al.: Retrospective revaluation of the significance of thyroid microsomal antibody in the treatment of Graves' disease. Acta Endocrinol. (Copenh.) 114: 328, 1987

    Google Scholar 

  22. Seto, P., Hirayu, H., Magnusson, R.P., et al.: Isolation of a complementary DNA clone for thyroid microsomal antigen: homology with the gene for thyroid peroxidase. J. Clin. Invest. 80: 1205, 1987

    Google Scholar 

  23. Khoury, E.L., Bottazo, G.F., Roitt, I.M.: The thyroid microsomal antibody revisited, its paradoxical binding in vivo to the apical surface of the follicular epithelium. J. Exp. Med. 159: 557, 1984

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Ito Hospital, 4-3-6 Jingumae, 150, Shibuya-ku, Tokyo, Japan

    Kiminori Sugino M.D., Takashi Mimura M.D., Osamu Ozaki M.D. & Kunihiko Ito M.D.

  2. First Department of Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, 236, Yokohama, Kanagawa, Japan

    Yoshio Kure M.D., Hiroyuki Iwasaki M.D., Nobuyuki Wada M.D. & Akihiko Matsumoto M.D.

Authors
  1. Kiminori Sugino M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takashi Mimura M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Osamu Ozaki M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yoshio Kure M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiroyuki Iwasaki M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nobuyuki Wada M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Akihiko Matsumoto M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kunihiko Ito M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sugino, K., Mimura, T., Ozaki, O. et al. Early recurrence of hyperthyroidism in patients with Graves' disease treated by subtotal thyroidectomy. World J. Surg. 19, 648–652 (1995). https://doi.org/10.1007/BF00294748

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00294748

Keywords

Search

Navigation