Changing trends in surgery for Graves’ disease: a cohort comparison of those having surgery intended to preserve thyroid function with those having ablative surgery

Journal of Otolaryngology-Head & Neck Surgery

Zygmunt H Krukowski¹  Wendy L Craig¹  Ailsa C Snaith²  Ahmed Al-Adhami¹ 

[1] Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK;Oxford Radcliffe Hospitals NHS Trust, Oxford, UK

关键词: Total thyroidectomy;    Subtotal thyroidectomy;    Thyroidectomy;    Hyperthyroidism;    Graves’ disease;   

Others  :  861741
DOI  :  10.1186/1916-0216-42-37

 received in 2012-11-17, accepted in 2013-05-25,  发布年份 2013

【 摘 要 】

Background

Surgery for Graves’ disease may be performed with the intent of preserving thyroid function (subtotal thyroidectomy) or ablating thyroid function (total thyroidectomy). This study examines the evolving practice in a specialist endocrine surgical unit.

Method

Longitudinal cohort study of patients undergoing surgery for Graves’ disease between 1986 and 2008. Outcome measures were thyroid failure, recurrent toxicity, recurrent laryngeal nerve (RLN) palsy, early reoperation and hypocalcaemia. Time to thyroid failure was analysed by potential predictors.

Results

Of 149 patients (129 female), 78 (52.3 percent) underwent subtotal thyroidectomy with the intention to preserve function (PF) and 71 (47.6 percent) total thyroidectomy with the intention to ablate thyroid function (AF). Mean duration of follow-up was 11.1 years; 14.8 years and 7.0 years respectively. Of 78 PF procedures: six (7.7 percent) patients suffered recurrent toxicity; 68 (87.2 percent) developed thyroid failure (four after treatment for recurrent toxicity); and eight (10 percent) remained euthyroid without replacement. Male gender and remnant gland weight were significant predictors of failure (P = 0.021 and 0.022 respectively). One patient developed permanent RLN palsy and one permanent hypocalcaemia. Of 71 AF procedures: one developed acute airway obstruction; one permanent RLN palsy; four permanent hypocalcaemia; and none developed recurrent toxicity. There were no deaths within a year of surgery. There was no statistically significant difference in complication rates.

Conclusion

Most PF resections resulted in eventual thyroid failure. The shift to ablative surgery virtually eliminated the need for lifelong specialist follow-up, albeit with an insignificant rise in permanent hypocalcaemia.

【 授权许可】

   
2013 Al-Adhami et al.; licensee BioMed Central Ltd.

【 图 表 】

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