J Korean Surg Soc.  2009 Aug;77(2):82-87. 10.4174/jkss.2009.77.2.82.

Surgical Treatment of Graves' Disease: Comparison between Total Thyroidectomy and Subtotal Thyroidectomy

• Sung TY
• Kim YS
• Lee SH
• Yoon JH
• Hong SJ

• KMID: 2211286
• DOI: http://doi.org/10.4174/jkss.2009.77.2.82

Abstract

PURPOSE
Subtotal thyroidectomy has been the standard operation for Graves' disease in achieving a favorable outcome in recovery of euthyroid state. However, the postoperative outcomes following subtotal thyroidectomy differ by surgeon and postoperative thyroid dysfunctions develop as time passes. Here, we have studied the validity of total thyroidectomy for Graves' disease patients, with a comparison to subtotal thyroidectomy. METHODS: A total of 299 patients with Graves' disease underwent thyroid operation consecutively in Asan Medical Center, Seoul, Korea from December 1995 to December 2005. Among them, 241 cases had subtotal thyroidectomy and 43 had total thyroidectomy. The subtotal thyroidectomy cases were divided into 3 groups according to estimated remnant thyroid; <4 g, 4< or =~<6 g and > or =6 g. Also, according to postoperative thyroid function, the patients were divided into euthyroid, hypothyroidism and hyperthyroidism groups. The postoperative changes of thyroid function, postoperative complications and hospital days were analyzed. RESULTS: In subtotal thyroidectomy, postoperative thyroid function showed euthyroid in 25 (10.4%), hypothyroidism 206 (85.5%) and hyperthyroidism 10 (4.1%). However, total thyroidectomy showed no persistent hyperthyroidism or recurrence. The postoperative thyroid function state changed in 24 patients out of 148 who had more than 2 years postoperative follow-up. Hyper-functional changes developed with higher rates (Hypo-6 vs. hyper-18). The postoperative complication rate was higher in subtotal thyroidectomy including bleeding, hoarseness and hypocalcemia. CONCLUSION: In our study, the patients showing normal thyroid function after subtotal thyroidectomy were very limited and thyroid dysfunction developed continuously with time lapse, especially towards hyperthyroid state. Therefore, we suggest that total thyroidectomy should be considered as a treatment option in Graves' disease.

Keyword

Graves' disease; Subtotal thyroidectomy; Total thyroidectomy; Thyroid function

MeSH Terms

Follow-Up Studies
Graves Disease
Hemorrhage
Hoarseness
Humans
Hyperthyroidism
Hypocalcemia
Hypothyroidism
Korea
Postoperative Complications
Recurrence
Thyroid Gland
Thyroidectomy

Figure

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  Fig. 1 Recurrence after subtotal thyroidectomy. Pattern of recurrence after subtotal thyroidectomy shows that recurrence continuously develops as time passes.

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  Fig. 2 Pattern of hypothyroidism change after subtotal thyroidectomy. Pattern of hypothyroidism change after subtotal thyroidectomy shows that hypo-functional change was developed within 1 year after the operation and only few newly developed hypothyroidism after 1 year.

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