Thyroidectomy for Graves' disease

Subtotal thyroidectomy appears to be the best choice of operation in patients with mild forms of Graves' disease in order to try to achieve a euthyroid state. Total thyroidectomy is probably the best operation for severe disease and large goiter in order to ensure that hyperthyroidism does not recur.

A systematic review including 35 studies with a total of 7 241 subjects was abstracted in DARE. The review compared total and subtotal thyroidectomy (TT and ST). Persistent or recurrent hyperthyroidism occurred in 7.2% of all patients. TT was performed on 538 patients and hypothyroidism occurred in all cases. ST was performed in 6 703 patients: 59.7% achieved euthyroidism, 25.6% became hypothyroid, and 7.9% had either persistent or recurrent hyperthyroidism. Permanent recurrent laryngeal nerve (RLN) injury occurred in 0.9% of TT patients and 0.7% of ST patients (P was non significant). Permanent hypoparathyroidism occurred in 0.9% of TT patients and 1.0% of ST patient (P was non significant).

There was an 8.9% decrease in hypothyroidism and a 6.9% increase in euthyroidism for each gram of thyroid remnant. There were no peri-operative mortalities reported in 4 470 operations. Incidental carcinoma was found in the resected thyroid tissue in 84 (4.5%) of the 1 882 patients.

Comment: The quality of evidence is downgraded by review quality.

Ədəbiyyat

1. Palit TK, Miller CC 3rd, Miltenburg DM. The efficacy of thyroidectomy for Graves' disease: A meta-analysis. J Surg Res 2000 May 15;90(2):161-5.