Advertisement

The long-term outcomes of thyroid function after subtotal thyroidectomy for Graves' hyperthyroidism

      Abstract

      Background

      Surgical management of Graves' disease (GD) is changing from subtotal to total thyroidectomy because the latter eliminates the risk of recurrence. However, to preserve thyroid function in a euthyroid state, subtotal thyroidectomy is still performed for GD in non-Western countries. Therefore, we designed a study to investigate the long-term outcomes in GD patients after subtotal thyroidectomy and the correlation between remnant weight and postoperative thyroid function.

      Materials and methods

      This was a retrospective cohort observation study. Between January 2005 and December 2011, 415 consecutive GD patients treated by subtotal thyroidectomy were enrolled. All data were collected from 385 patients who underwent bilateral subtotal thyroidectomy and 57 patients who underwent the Hartley-Dunhill operation. The median postoperative follow-up time was 72 months (range 12-144 months).

      Results

      The mean weight of the preserved thyroid remnant was 5.1 g. Persistent or recurrent hyperthyroidism was observed in 119 (28.7%) patients. The median time of recurrence was 36 months (range 12-120 months). Hypothyroidism developed in over 50% of patients. A euthyroid state was achieved in only 19.3% of patients, and the rate did not increase significantly as remnant weight increased. Based on a Cox regression analysis, the remnant weight is an independent risk factor for persistent or recurrent hyperthyroidism (hazard ratio: 1.323, 95% confidence interval: 1.198-1.461, P < 0.001).

      Conclusions

      Subtotal thyroidectomy with the intent to maintain a euthyroid state is not an optimal surgical strategy for the definitive treatment of GD because the persistence or recurrence rate is high and the euthyroid rate is lower than expected.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Surgical Research
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Schüssler-Fiorenza C.M.
        • Bruns C.M.
        • Chen H.
        The surgical management of Graves' disease.
        J Surg Res. 2006; 133: 207-214
        • Genovese B.M.
        • Noureldine S.I.
        • Gleeson E.M.
        • Tufano R.P.
        • Kandil E.
        What is the best definitive treatment for Graves' disease? A systematic review of the existing literature.
        Ann Surg Oncol. 2013; 20: 660-667
        • In H.
        • Pearce E.N.
        • Wong A.K.
        • Burgess J.F.
        • McAneny D.B.
        • Rosen J.E.
        Treatment options for Graves disease: a cost-effectiveness analysis.
        J Am Coll Surg. 2009; 209: 170-179.e1
        • Ross D.S.
        • Burch H.B.
        • Cooper D.S.
        • et al.
        2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis.
        Thyroid. 2016; 26: 1343-1421
        • Stålberg P.
        • Svensson A.
        • Hessman O.
        • Akerström G.
        • Hellman P.
        Surgical treatment of Graves' disease: evidence-based approach.
        World J Surg. 2008; 32: 1269-1277
        • Feroci F.
        • Rettori M.
        • Borrelli A.
        • et al.
        A systematic review and meta-analysis of total thyroidectomy versus bilateral subtotal thyroidectomy for Graves'disease.
        Surgery. 2014; 155: 529-540
        • Palit T.K.
        • Miller 3rd, C.C.
        • Miltenburg D.M.
        The efficacy of thyroidectomy for Graves' disease: a meta-analysis.
        J Surg Res. 2000; 90: 161-165
        • Sugino K.
        • Mimura T.
        • Ozaki O.
        • et al.
        Early recurrence of hyperthyroidism in patients with Graves' disease treated by subtotal thyroidectomy.
        World J Surg. 1995; 19: 648-652
        • Sung T.Y.
        • Lee Y.M.
        • Yoon J.H.
        • Chung K.W.
        • Hong S.J.
        Long-term effect of surgery in Graves' disease : 20 years experience in a single institution.
        Int J Endocrinol. 2015; 2015: 542641https://doi.org/10.1155/2015/542641
        • Järhult J.
        • Andersson P.O.
        • Duncker L.
        Alternating from subtotal thyroid resection to total thyroidectomy in the treatment of Graves' disease prevents recurrences but increases the frequency of permanent hypoparathyroidism.
        Langenbecks Arch Surg. 2012; 397: 407-412
        • Werga-Kjellman P.
        • Zedenius J.
        • Tallstedt L.
        • Träisk F.
        • Lundell G.
        • Wallin G.
        Surgical treatment of hyperthyroidism: a ten-year experience.
        Thyroid. 2001; 11: 187-192
        • Kasuga Y.
        • Sugenoya A.
        • Kobayashi S.
        • et al.
        Clinical evaluation of the response to surgical treatment of Graves' disease.
        Surg Gynecol Obstet. 1990; 170: 327-330
        • Müller P.E.
        • Bein B.
        • Robens E.
        • Bein H.S.
        • Spelsberg F.
        Thyroid surgery according to Enderlen-Hotz or Dunhill: a comparison of two surgical methods for the treatment of Graves.
        Int Surg. 2001; 86: 112-116
        • Chi S.Y.
        • Hsei K.C.
        • Sheen-Chen S.M.
        • Chou F.F.
        A prospective randomized comparison of bilateral subtotal thyroidectomy versus unilateral total and contralateral subtotal thyroidectomy for Graves' disease.
        World J Surg. 2005; 29: 160-163
        • Barczyński M.
        • Konturek A.
        • Hubalewska-Dydejczyk A.
        • Gołkowski F.
        • Nowak W.
        Randomized clinical trial of bilateral subtotal thyroidectomy versus total thyroidectomy for Graves' disease with a 5-year follow-up.
        Br J Surg. 2012; 99: 515-522
        • Guo Z.
        • Yu P.
        • Liu Z.
        • Si Y.
        • Jin M.
        Total thyroidectomy vs bilateral subtotal thyroidectomy in patients with Graves' diseases: a meta-analysis of randomized clinical trials.
        Clin Endocrinol (Oxf). 2013; 79: 739-746
        • Sugino K.
        • Ito K.
        • Nagahama M.
        • et al.
        Changes in the thyroid function of Graves' disease patients treated by subtotal thyroidectomy.
        Endocr J. 2012; 59: 1115-1120
        • Al-Adhami A.
        • Snaith A.C.
        • Craig W.L.
        • Krukowski Z.H.
        Changing trends in surgery for Graves' disease: a cohort comparison of those having surgery intended to preserve thyroid function with those having ablative surgery.
        J Otolaryngol Head Neck Surg. 2013; 42: 37https://doi.org/10.1186/1916-0216-42-37