Total Thyroidectomy in Graves' Disease

Han, Sehwan; Ko, Kyung Soo; Rhee, Byoung Doo; Lee, Myung Soo; Kim, Hong Joo; Kim, Young Duck; Kim, Hong Yong

Abstract

BACKGROUND: The optimal extent of thyroid resection in Graves' disease has not been clearly determined. A significant proportion of patients experience recurrence of the disease after subtotal thyroidectomy. Total thyroidectomy can eliminate the source of the disease. However, many surgeons are reluctant to conduct a total thyroidectomy because it has been known to be associated with increased postoperative morbidity.
METHODS
Thirty-six patients underwent subtotal thyroidectomy (ST, n=19) or total/near total thyroidectomy (T/NT, n=17) for Graves' disease after treatment with antithyroid drugs. Relapse of the hyperthyroidism, surgical complications, and serum calcium levels were evaluated.
RESULTS
Operation time was not prolonged by the extent of thyroidectomy (ST: 106+/-32.1 min., T/NT: 118+/-34.3 min.). Transient hypocalcemia was observed in 5 patients (29.4%) after a total or a near total thyroidectomy, whereas 3 patients (15.7%) experienced transient hypocalcemia after a subtotal thyroidectomy. All patients showed normal serum calcium level 1 month after the operation and had become free of hypocalcemic symptoms. No patient had injury to the recurrent laryngeal nerve, regardless of the extent of the surgery. Recurrence of the hyperthyroidism was observed in 3 patients who had undergone a subtotal thyroidectomy.
CONCLUSIONS
Total thyroidectomy can be conducted safely in patients with Graves' disease without any increase in postoperative complications, such as hypoparathyroidism or injury to the recurrent laryngeal nerve. Therefore, total thyroidectomy appears to be an effective alternative treatment modality for Graves' disease.