World Journal of Endocrine Surgery

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VOLUME 10 , ISSUE 2 ( May-August, 2018 ) > List of Articles

ORIGINAL ARTICLE

Surgical Management of Graves’ Disease over a 25-year Period in a Single Institution: Comparison of Outcomes between Subtotal Thyroidectomy and Total Thyroidectomy

Su A Lui, Jun L Teh, Yong X Gwee, Clifton Tay, Jesse Hu, Kee Y Ngiam, Charles TK Tan, Abu Rauff, Wee B Tan, Wei K Cheah

Keywords : Graves’ disease, Outcome, Thyroidectomy.

Citation Information : Lui SA, Teh JL, Gwee YX, Tay C, Hu J, Ngiam KY, Tan CT, Rauff A, Tan WB, Cheah WK. Surgical Management of Graves’ Disease over a 25-year Period in a Single Institution: Comparison of Outcomes between Subtotal Thyroidectomy and Total Thyroidectomy. World J Endoc Surg 2018; 10 (2):103-107.

DOI: 10.5005/jp-journals-10002-1228

License: CC BY-NC 4.0

Published Online: 01-07-2007

Copyright Statement:  Copyright © 2018; The Author(s).


Abstract

Introduction: Surgery is offered to patients with Graves’ disease (GD) refractory to medical or radio-iodine therapy. Total thyroidectomy (TT) has been shown to lower recurrence rates of hyperthyroidism but subtotal thyroidectomy (ST) is thought to be associated with lower risk of postoperative complications. The aim of this study was to compare the postoperative outcomes of TT vs ST in the Singaporean population and identify risk factors that might predispose to treatment failure after ST. Materials and methods: This is a retrospective review of consecutive patients who underwent surgery for GD at a single institution in Singapore. Patients who underwent thyroid surgery for GD between January 1991 and December 2015 were included in the study. The primary outcomes studied were rates of recurrent hyperthyroidism, hypocalcemia, recurrent laryngeal nerve injury, and length of stay postsurgery. The secondary outcome was to compare whether preoperative thyroid function and antibody levels predicted for treatment failure post-ST. Results: Over a 25-year period, 79 patients underwent ST and 38 patients underwent TT. The rate of hyperthyroidism relapse post-ST was 20.3% compared with 0% post-TT (p < 0.01). There was no difference between the length of stay, or recurrent laryngeal nerve injury between patients who underwent ST compared with TT. Preoperative antibody levels and biochemical hyperthyroidism did not predict treatment failure after ST. Conclusion: Total thyroidectomy is a more definitive surgical procedure for patients with GD refractory to medical therapy with lower risk of disease relapse and similar temporary and long-term risk of complications when compared with ST.


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  1. Kurihara H. Total thyroidectomy for the treatment of hyperthyroidism in patients with ophthalmopathy. Thyroid 2002 Mar;12(3):265-267.
  2. Lowery AJ, Kerin MJ. Graves’ ophthalmopathy: the case for thyroid surgery. Surgeon 2009 Oct;7(5):290-296.
  3. Chi SY, Hsei KC, Sheen-Chen SM, Chou FF. A prospective randomized comparison of bilateral subtotal thyroidectomy versus unilateral total and contralateral subtotal thyroidectomy for Graves’ disease. World J Surg 2005 Feb;29(2):160-163.
  4. Guo Z, Yu P, Liu Z, Si Y, Jin M. Total thyroidectomy vs bilateral subtotal thyroidectomy in patients with Graves’ diseases: a meta-analysis of randomized clinical trials. Clin Endocrinol (Oxf) 2013 Nov;79(5):739-746.
  5. Hoffmann R. Thyroidectomy in Graves’ disease: subtotal, near total or total? Orbit 2009;28(4):241-244.
  6. Hermann M, Roka R, Richter B, Freissmuth M. Early relapse after operation for Graves’ disease: postoperative hormone kinetics and outcome after subtotal, near-total, and total thyroidectomy. Surgery 1998 Nov;124(5):894-900.
  7. Catania A, Guaitoli E, Carbotta G, Bianchini M, Di Matteo FM, Carbotta S, Nardi M, Fabiani E, Grani G, D'Andrea V, et al. Total thyroidectomy for Graves’ disease treatment. Clin Ter 2013 May-Jun;164(3):193-196.
  8. Barakate MS, Agarwal G, Reeve TS, Barraclough B, Robinson B, Delbridge LW. Total thyroidectomy is now the preferred option for the surgical management of Graves’ disease. ANZ J Surg 2002 May;72(5):321-324.
  9. Bahn Chair RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid 2011 Jun;21(6):593-646.
  10. Robert J, Mariéthoz S, Pache JC, Bertin D, Caulfield A, Murith N, Peytremann A, Goumaz M, Garcia B, Martin-Du Pan R, et al. Short- and long-term results of total vs subtotal thyroidectomies in the surgical treatment of Graves’ disease. Swiss Surg 2001 Feb;7(1):20-24.
  11. Werga-Kjellman P, Zedenius J, Tallstedt L, Träisk F, Lundell G, Wallin G. Surgical treatment of hyperthyroidism: a ten-year experience. Thyroid 2001 Feb;11(2):187-192.
  12. Lepner U, Seire I, Palmiste V, Kirsimägi U. Surgical treatment of Graves’ disease: subtotal thyroidectomy might still be the preferred option. Medicina (Kaunas) 2008;44(1):22-26.
  13. Witte J, Goretzki PE, Dotzenrath C, Simon D, Felis P, Neubauer M, Röher HD. Surgery for Graves’ disease: total versus subtotal thyroidectomy-results of a prospective randomized trial. World J Surg 2000 Nov;24(11):1303-1311.
  14. Jarhult J, Rudberg C, Larsson E, Selvander H, Sjövall K, Winsa B, Rastad J, Karlsson FA; TEO Study Group. Graves’ disease with moderate-severe endocrine ophthalmopathy-long term results of a prospective, randomized study of total or subtotal thyroid resection. Thyroid 2005 Oct;15(10):1157-1164.
  15. Liu ZW, Masterson L, Fish B, Jani P, Chatterjee K. Thyroid surgery for Graves’ disease and Graves’ ophthalmopathy. Cochrane Database Syst Rev 2015 Nov;11:CD010576.
  16. Kuma K, Matsuzuka F, Kobayashi A, Hirai K, Fukata S, Tamai H, Miyauci A, Sugawara M. Natural course of Graves’ disease after subtotal thyroidectomy and management of patients with postoperative thyroid dysfunction. Am J Med Sci 1991 Jul;302(1):8-12.
  17. Sugino K, Mimura T, Ozaki O, Kure Y, Iwasaki H, Wada N, Matsumoto A, Ito K. Early recurrence of hyperthyroidism in patients with Graves’ disease treated by subtotal thyroidectomy. World J Surg 1995 Jul-Aug;19(4):648-652.
  18. Annerbo M, Stalberg P, Hellman P. Management of Grave's disease is improved by total thyroidectomy. World J Surg 2012 Aug;36(8):1943-1946.
  19. Hedley AJ, Bewsher PD, Jones SJ, Khir AS, Clements P, Matheson NA, Gunn A. Late onset hypothyroidism after subtotal thyroidectomy for hyperthyroidism: implications for long term follow-up. Br J Surg 1983 Dec;70(12):740-743.
  20. Nonchev BI, Terzieva DD, Dimov RS, Mateva NG, Tsvetkova TZ, Dimitrakov DY. Early hypothyroidism after subtotal thyroidectomy in patients with Graves’ disease–the role of the preoperative conservative treatment and hormonal status. Folia Med (Plovdiv) 2005;47(3-4):40-45.
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