Thyroid Function After Subtotal Thyroidectomy in Patients with Graves' Hyperthyroidism

Overview

Journal ScientificWorldJournal

Publisher Wiley

Specialty Biology

Date 2012 Mar 27

PMID 22448136

Citations 7

Authors

E J Limonard

P H Bisschop

E Fliers

E J Nieveen van Dijkum

Affiliations

Soon will be listed here.

Abstract

Background: Subtotal thyroidectomy is a surgical procedure, in which the surgeon leaves a small thyroid remnant in situ to preserve thyroid function, thereby preventing lifelong thyroid hormone supplementation therapy.

Aim: To evaluate thyroid function after subtotal thyroidectomy for Graves' hyperthyroidism.

Subjects And Methods: We retrospectively reviewed the medical records of all patients (n = 62) who underwent subtotal thyroidectomy for recurrent Graves' hyperthyroidism between 1992 and 2008 in our hospital. Thyroid function was defined according to plasma TSH and free T4 values.

Results: Median followup after operation was 54.6 months (range 2.1-204.2 months). Only 6% of patients were euthyroid after surgery. The majority of patients (84%) became hypothyroid, whereas 10% of patients had persistent or recurrent hyperthyroidism. Permanent recurrent laryngeal nerve palsy and permanent hypocalcaemia were noted in 1.6% and 3.2% of patients, respectively.

Conclusion: In our series, subtotal thyroidectomy for Graves' hyperthyroidism was associated with a high risk of postoperative hypothyroidism and a smaller, but significant, risk of persistent hyperthyroidism. Our data suggest that subtotal thyroidectomy seems to provide very little advantage over total thyroidectomy in terms of postoperative thyroid function.

Citing Articles

Mechanisms and Treatment Options for Hyperthyroid-Induced Osteoporosis: A Narrative Review.

Branstetter 4th R, Islam R, Toups C, Parra A, Lee Z, Ahmadzadeh S Cureus. 2023; 15(11):e48798.

PMID: 38098934 PMC: 10720926. DOI: 10.7759/cureus.48798.

A Case of Recurrent Thyrotoxicosis in a Thyroglossal Duct Cyst 18 Years Following Thyroid Surgery.

Baghaffar M, Samargandy S Cureus. 2023; 15(6):e39829.

PMID: 37397661 PMC: 10314736. DOI: 10.7759/cureus.39829.

Carbimazole-Induced Agranulocytosis in a Previously Stable Patient: A Case Report and Literature Review.

Khan Z, Afifi W, Muhammad S, Warrier V Cureus. 2022; 14(4):e24115.

PMID: 35573582 PMC: 9106535. DOI: 10.7759/cureus.24115.

Short-Term Outcomes of Surgery for Graves' Disease in Germany.

Maurer E, Vorlander C, Zielke A, Dotzenrath C, Frankenberg M, Kohler H J Clin Med. 2020; 9(12).

PMID: 33322553 PMC: 7763951. DOI: 10.3390/jcm9124014.

Retrospective Study of Tc-99m Thyroid Scan in Patients with Graves' Disease: Is There Significant Difference in Lobar Activity?.

Wagieh S, Salman K, Bakhsh A, Talaat O, Al Morsy S, Al-Ezzi M Indian J Nucl Med. 2020; 35(2):122-129.

PMID: 32351266 PMC: 7182335. DOI: 10.4103/ijnm.IJNM_186_19.

References

Kuma K, Matsuzuka F, Kobayashi A, Hirai K, Fukata S, Tamai H . Natural course of Graves' disease after subtotal thyroidectomy and management of patients with postoperative thyroid dysfunction. Am J Med Sci. 1991; 302(1):8-12. DOI: 10.1097/00000441-199107000-00003. View

Palit T, Miller 3rd C, Miltenburg D . The efficacy of thyroidectomy for Graves' disease: A meta-analysis. J Surg Res. 2000; 90(2):161-5. DOI: 10.1006/jsre.2000.5875. View

Sivanandan R, Ng L, Khin L, Lim T, Soo K . Postoperative endocrine function in patients with surgically treated thyrotoxicosis. Head Neck. 2004; 26(4):331-7. DOI: 10.1002/hed.10389. View

Bahn Chair R, Burch H, Cooper D, Garber J, Greenlee M, Klein I . Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Thyroid. 2011; 21(6):593-646. DOI: 10.1089/thy.2010.0417. View

Witte J, Goretzki P, Dotzenrath C, Simon D, Felis P, Neubauer M . Surgery for Graves' disease: total versus subtotal thyroidectomy-results of a prospective randomized trial. World J Surg. 2000; 24(11):1303-11. DOI: 10.1007/s002680010216. View

Miccoli P, Vitti P, Rago T, Iacconi P, Bartalena L, Bogazzi F . Surgical treatment of Graves' disease: subtotal or total thyroidectomy?. Surgery. 1996; 120(6):1020-4; discussion 1024-5. DOI: 10.1016/s0039-6060(96)80049-3. View

Robert J, Mariethoz S, Pache J, Bertin D, Caulfield A, Murith N . Short- and long-term results of total vs subtotal thyroidectomies in the surgical treatment of Graves' disease. Swiss Surg. 2001; 7(1):20-4. DOI: 10.1024/1023-9332.7.1.20. View

Chi S, Hsei K, Sheen-Chen S, Chou F . A prospective randomized comparison of bilateral subtotal thyroidectomy versus unilateral total and contralateral subtotal thyroidectomy for graves' disease. World J Surg. 2005; 29(2):160-3. DOI: 10.1007/s00268-004-7529-7. View

Sugino K, Ito K, Nagahama M, Kitagawa W, Shibuya H, Ito K . Surgical management of Graves' disease -10-year prospective trial at a single institution. Endocr J. 2008; 55(1):161-7. DOI: 10.1507/endocrj.k07e-013. View

10.

Lepner U, Seire I, Palmiste V, Kirsimagi U . Surgical treatment of Graves' disease: subtotal thyroidectomy might still be the preferred option. Medicina (Kaunas). 2008; 44(1):22-6. View

11.

Barakate M, Agarwal G, Reeve T, Barraclough B, Robinson B, Delbridge L . Total thyroidectomy is now the preferred option for the surgical management of Graves' disease. ANZ J Surg. 2002; 72(5):321-4. DOI: 10.1046/j.1445-2197.2002.02400.x. View

12.

Weber K, Solorzano C, Lee J, Gaffud M, Prinz R . Thyroidectomy remains an effective treatment option for Graves' disease. Am J Surg. 2006; 191(3):400-5. DOI: 10.1016/j.amjsurg.2005.10.043. View

13.

Chou F, Wang P, Huang S . Results of subtotal thyroidectomy for Graves' disease. Thyroid. 1999; 9(3):253-7. DOI: 10.1089/thy.1999.9.253. View

14.

Moreno P, Gomez J, Gomez N, Francos J, Ramos E, Rafecas A . Subtotal thyroidectomy: a reliable method to achieve euthyroidism in Graves' disease. Prognostic factors. World J Surg. 2006; 30(11):1950-6. DOI: 10.1007/s00268-005-0770-x. View

15.

Stalberg P, Svensson A, Hessman O, Akerstrom G, Hellman P . Surgical treatment of Graves' disease: evidence-based approach. World J Surg. 2008; 32(7):1269-77. DOI: 10.1007/s00268-008-9497-9. View

16.

Ku C, Lo C, Chan W, Kung A, Lam K . Total thyroidectomy replaces subtotal thyroidectomy as the preferred surgical treatment for Graves' disease. ANZ J Surg. 2005; 75(7):528-31. DOI: 10.1111/j.1445-2197.2005.03441.x. View

17.

Andaker L, Johansson K, Smeds S, Lennquist S . Surgery for hyperthyroidism: hemithyroidectomy plus contralateral resection or bilateral resection? A prospective randomized study of postoperative complications and long-term results. World J Surg. 1992; 16(4):765-9. DOI: 10.1007/BF02067381. View

18.

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. 1992; 16(4):690-5; discussion 695-6. DOI: 10.1007/BF02067359. View

19.

Lal G, Ituarte P, Kebebew E, Siperstein A, Duh Q, Clark O . Should total thyroidectomy become the preferred procedure for surgical management of Graves' disease?. Thyroid. 2005; 15(6):569-74. DOI: 10.1089/thy.2005.15.569. View

20.

Sugino K, Mimura T, Ozaki O, Kure Y, Iwasaki H, Wada N . Early recurrence of hyperthyroidism in patients with Graves' disease treated by subtotal thyroidectomy. World J Surg. 1995; 19(4):648-52. DOI: 10.1007/BF00294748. View