[Subtotal resection of thyroid gland - optimal method for threatment of Bazedow disease. Prognosis]

Subtotal thyroidectomy is a widely accepted surgical procedure for Basedow disease. The purpose of this work is to evaluate functional long-term results and determine predictive prognostic factors of postoperative thyroid function. This is a retrospective study conducted on 207 patients with Basedow disease undergoing subtotal thyroidectomy during the period 1983-2004. Predictive prognostic factors of final thyroid status were investigated and probability of hypothyroidism during the years of follow-up was obtained by the Kaplan-Meier method. Surgery controlled hyperthyroidism in 199 out of 207 patients (97%). The probability of hypo-, eu-, and hyperthyroidism at 5 years was 63%, 36%, and 2%, respectively. No statistical change in thyroid function occurred in the follow-up after 5 years. Multivariate analysis by a logistic ordinal regression analysis showed that weight of the remnant, age, and gender seemed to influence long-term thyroid function. The higher rates of euthyroidism were obtained when the remnant weight was between 6 and 8 g. No recurrence or persistence of hyperthyroidism occurred with remnant weights under 5 g. Subtotal thyroidectomy controlled hyperfunction symptoms in 97% of our patients. Cure (euthyroidism) of Basedow disease patients should be attempted by leaving a thyroid tissue remnant between 6 and 8 g. Even more significant, our results suggest that euthyroidism rates could be improved by leaving a smaller remnant in elderly women and greater remnants in young men. No need for long term medical therapy is emphasised.