Total thyroidectomy is now the preferred option for the surgical management of Graves’ disease
- 27 May 2002
- journal article
- research article
- Published by Wiley in Anz Journal of Surgery
- Vol. 72 (5), 321-324
- https://doi.org/10.1046/j.1445-2197.2002.02400.x
Abstract
Purpose: Subtotal thyroidectomy has been advocated as the standard treatment for Graves’ disease because of the possibility of avoiding thyroxine therapy as well as the assumed lower risk of complications compared to total thyroidectomy. However, the long‐term results of subtotal thyroidectomy are not as good as they were previously believed to be, as evidenced by the increasing incidence of hypothyroidism. If the risk of complications from total thyroidectomy is no higher, then that procedure offers significant advantages in the surgical management of Graves’ disease. The aim of this study therefore was to compare the complication rate of the two procedures in patients with Graves’ disease. Methods: This was a retrospective case control study in a tertiary referral hospital. Information was obtained from an endocrine surgery database over the study period from January 1957 to December 2000. During that period 1246 patients with Graves’ disease underwent subtotal thyroidectomy and 119 patients underwent total thyroidectomy. Results: Prior to 1987 total thyroidectomy was rarely if ever performed whereas in the last 12 months total thyroidectomy comprised 95% of all procedures. There was no significant difference in the rate of permanent complications between the two procedures although temporary hypocalcaemia was significantly more common following total thyroidectomy. Permanent hypoparathyroidism resulted in one patient each who underwent total thyroidectomy (0.8%) and subtotal thyroidectomy (0.1%). Permanent recurrent laryngeal nerve palsy occurred in one patient who underwent total thyroidectomy (0.8%) and 5 patients undergoing subtotal thyroidectomy (0.4%). Conclusion: Given that subtotal thyroidectomy provides an unpredictable outcome and that the risk of permanent complications is no greater than with total thyroidectomy, there appears little logical reason to continue to recommend subtotal thyroidectomy for the surgical management of Graves’ disease. We believe that Graves’ disease should join the increasing list of thyroid conditions for which total thyroidectomy is the preferred option.Keywords
This publication has 21 references indexed in Scilit:
- Total Thyroidectomy for Benign Thyroid Disorders in an Endemic RegionWorld Journal of Surgery, 2001
- Surgeon's Approach to the Thyroid Gland: Surgical Anatomy and the Importance of TechniqueWorld Journal of Surgery, 2000
- Total Thyroidectomy for Management of Thyroid DiseaseWorld Journal of Surgery, 2000
- The Efficacy of Thyroidectomy for Graves' Disease: A Meta-analysisJournal of Surgical Research, 2000
- Progressive Increase in Thyroid Dysfunction after Subtotal Thyroidectomy for Graves' DiseaseAsian Journal of Surgery, 2000
- Total Thyroidectomy for Bilateral Benign Multinodular GoiterArchives of Surgery, 1999
- ROUTINE AUTOTRANSPLANTATION OF AT LEAST ONE PARATHYROID GLAND DURING TOTAL THYROIDECTOMY MAY REDUCE PERMANENT HYPOPARATHYROIDISM TO ZEROAnz Journal of Surgery, 1999
- Surgical treatment of graves' disease: Subtotal or total thyroidectomy?Surgery, 1996
- Retrospective evaluation of subtotal and total thyroidectomy in Graves' disease with and without endocrine ophthalmopathyActa Endocrinologica, 1995
- Surgical treatment of Graves' disease0The American Journal of Surgery, 1988