[Role of surgery in the treatment of diffuse hyperthyroidisms]

A prospective study was set up to help in the choice of treatment for diffuse hyperthyroidism: antithyroid drugs, radioactive iodine or surgery? Over a 20-year period 477 patients with diffuse hyperthyroidism were operated upon and followed up every year. Early complications were uncommon; permanent functional sequelae, usually not troublesome, were observed in only 1.8 percent of the cases. The endocrine status obtained remained stable beyond 2 years in 98 percent of the patients. Ten years after surgery, failure or relapse were recorded in 3 percent of the cases, hypothyroidism in 27 percent and euthyroidism in 78 percent. These results appear to be better than those of the other methods reported in the literature. Antithyroid drugs expose to relapse in 50 percent of the cases. With radioactive iodine, the cumulative incidence of hypothyroidism is 3.6 percent per year and 100 percent in 30 years. The recent preference for non-surgical therapeutic methods does not seem to be soundly founded. Except when diffuse hyperthyroidism occurs in adolescents or in elderly or high surgical risk adults, surgery performed by a well-trained multidisciplinary team deserves to be considered.