J Korean Surg Soc.
2000 Apr;58(4):494-501.
Surgical Treatment of Graves' Disease
- Affiliations
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- 1Department of General Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- 2Department of Diagnostic Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
- 3Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Abstract
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PURPOSE: Graves' disease can be treated with antithyroid medication, radioiodine, or a
thyroidectomy. Antithyroid medication is less likely to achieve a permanent remission than
radioiodine or thyroidectomy. Radioiodine is preferred in the United States and antithyroid
medication is used more often in Europe. However a thyroidectomy is less preferred as a
primary therapy and is used only in the cases of recurrence or no response to medication.
METHODS
We studied 152 patients with Graves' disease who had been treated at Samsung
Medical Center. Fifty seven patients of them were surgically managed after antithyroid
medication, and the rest of them were managed medically. Patient's age, sex, symptoms, thyroid
fuction, autoantibody, treatment method and recurrence were retrospectively analyzed. RESULTS:
Women had Graves' disease more frequently than men a thyroidectomy was performed more
often in women and relatively young patients. The symptoms of Graves' disease were neck
mass, palpitation, eye symptoms, weight loss and etc. The response to treatment was much
higher in the thyroidectomy group than in the medically treated group. And more patients in
surgically treatmented group had their thyroid function normalized. A subtotal thyroidectomy
was performed in all patient and a mean of 7.4 g of thyroid tissue was remained.
Hypothyroidism was noted in 7 patients (12.3%), permanent hypocalcemia in 1 (1.8%), vocal
cord paralysis in 1 (1.8%) and transient hoarseness, transient hypocalcemia in the others.
Recurrences were noted in 4 patients. There was no correlation between recurrence and
remnant thyroid mass. However, preoperative TBII (thyrotropine binding inhibiting
immunoglobulin) values were higher in recurrence group and immediate and late postoperative
values were also higher than in the recovered group. CONCLUSION: A thyroidectomy is the
treatment of choice in Graves' disease. However, further investigation will be needed to predict
thyroid the function after a thyroidectomy for Graves' disease