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Alternating from subtotal thyroid resection to total thyroidectomy in the treatment of Graves’ disease prevents recurrences but increases the frequency of permanent hypoparathyroidism

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Abstract

Purpose

This study aims to compare the results of three different surgical techniques in the treatment of Graves’ disease.

Methods

All patients operated on due to Graves’ disease at a single institution between 1985 and 2009 were followed up for a median time of 152 months. The same endocrine surgeon operated altogether 265 patients; 111 with bilateral subtotal thyroid resection, 65 with lobectomy + unilateral subtotal resection (Dunhill’s operation) and 99 with total thyroidectomy.

Results

Recurrence of thyreotoxicosis was seen in 11 (9.9%) patients operated on with bilateral thyroid resection, in two (3.1%) of those operated on with Dunhill’s method and in none treated with total thyroidectomy. Permanent hypoparathyroidism was observed in 6% of the patients with total thyroidectomy, in 0.9% of those operated with bilateral subtotal resection and in none of the patients with Dunhill’s procedure (p < 0.001). The frequency of permanent paresis of one recurrent laryngeal nerve was 2%, 0% and 1.5%, respectively, in the three different groups. At follow-up, thyroxine supplementation therapy was given to 81 (73%) of the patients treated with bilateral subtotal resection, to 58 (89%) of those treated with Dunhill’s operation and to all of those treated with total thyroidectomy.

Conclusions

It is concluded that surgical treatment of Graves’ disease with Dunhill’s procedure, leaving a remnant of 1–2 g, seems to minimize the risks of both recurrences and permanent hypoparathyroidism.

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Acknowledgement

The authors are grateful to Dr. Adrian Meehan for revising the English text.

Disclosure statement

No competing financial interests exist.

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Authors and Affiliations

  1. Department of Surgery, Highland Hospital, Höglandssjukhuset, 57581, Eksjö, Sweden

    Johannes Järhult & Linda Duncker

  2. Department of Internal Medicine, Highland Hospital, Höglandssjukhuset, 57581, Eksjö, Sweden

    Per-Olof Andersson

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  1. Johannes Järhult
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  2. Per-Olof Andersson
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  3. Linda Duncker
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Correspondence to Johannes Järhult.

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Järhult, J., Andersson, PO. & Duncker, L. Alternating from subtotal thyroid resection to total thyroidectomy in the treatment of Graves’ disease prevents recurrences but increases the frequency of permanent hypoparathyroidism. Langenbecks Arch Surg 397, 407–412 (2012). https://doi.org/10.1007/s00423-011-0886-4

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  • DOI: https://doi.org/10.1007/s00423-011-0886-4

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