Subtotal thyroidectomy for thyrotoxicosis: a reassessment, including TRH responsiveness.

Area of Science:

• Endocrinology
• Thyroidology
• Surgical Outcomes

Background:

• Thyrotoxicosis, or hyperthyroidism, is a condition of excess thyroid hormones.
• Surgical treatment for thyrotoxicosis aims for a permanent cure but carries risks of relapse and hypothyroidism.
• Long-term follow-up is crucial to assess the durability and safety of surgical interventions for thyroid disorders.

Purpose of the Study:

• To evaluate the long-term thyroid function in patients surgically treated for thyrotoxicosis.
• To determine the incidence of recurrent thyrotoxicosis, hypothyroidism, and the need for thyroid hormone replacement post-surgery.
• To assess thyroid reserve in euthyroid patients using thyrotropin-releasing hormone (TRH) stimulation tests.

Main Methods:

• Retrospective analysis of patients surgically treated for thyrotoxicosis between 1965 and 1972.
• Clinical and biochemical reassessment of thyroid status.
• Thyroid function tests including TSH levels.
• TRH stimulation tests in a subset of euthyroid patients.

Main Results:

• Of 89 patients, 78 were reassessed; 71 were clinically and biochemically euthyroid.
• Seven patients relapsed and received radioiodine therapy; 10 required thyroxine replacement.
• Among euthyroid patients, over a third showed reduced thyroid reserve indicated by exaggerated TSH responses to TRH.

Conclusions:

• Surgical management of thyrotoxicosis can lead to long-term euthyroidism for most patients.
• A significant minority of patients may experience relapse or develop hypothyroidism requiring ongoing management.
• Thyroid reserve may be compromised even in biochemically euthyroid patients post-thyroid surgery, suggesting a need for vigilant monitoring.