Total thyroidectomy is now the preferred option for the surgical management of graves' disease.

摘要

PURPOSE: Subtotal thyroidectomy has been advocated as the standard treatmentfor Graves' disease because of the possibility of avoidingthyroxine therapy as well as the assumed lower risk of complicationscompared to total thyroidectomy. However, the long-term resultsof subtotal thyroidectomy are not as good as they were previouslybelieved 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 surgicalmanagement of Graves' disease. The aim of this study thereforewas to compare the complication rate of the two procedures in patientswith Graves' disease. METHODS: This was a retrospective case control study in a tertiary referralhospital. Information was obtained from an endocrine surgery databaseover the study period from January 1957 to December 2000. Duringthat period 1246 patients with Graves' disease underwentsubtotal thyroidectomy and 119 patients underwent total thyroidectomy. RESULTS: Prior to 1987 total thyroidectomy was rarely if ever performedwhereas in the last 12 months total thyroidectomy comprised95% of all procedures. There was no significant differencein the rate of permanent complications between the two procedures althoughtemporary hypocalcaemia was significantly more common followingtotal thyroidectomy. Permanent hypoparathyroidism resulted in onepatient each who underwent total thyroidectomy (0.8%) andsubtotal thyroidectomy (0.1%). Permanent recurrent laryngealnerve 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 outcomeand that the risk of permanent complications is no greater thanwith total thyroidectomy, there appears little logical reason tocontinue to recommend subtotal thyroidectomy for the surgical managementof Graves' disease. We believe that Graves' diseaseshould join the increasing list of thyroid conditions for whichtotal thyroidectomy is the preferred option.