Impact of Autoimmune Disease on Outcomes After Total Thyroidectomy for Thyrotoxicosis

Thyrotoxicosis with diffuse goiter is most commonly caused by Graves disease, which frequently coexists with other autoimmune diseases (ADs). Although total thyroidectomy is a definitive treatment in select cases, there is a lack of comprehensive data on how ADs influence surgical outcomes. This study evaluates complication rates within 90 d of surgery among patients undergoing total thyroidectomy for thyrotoxicosis with diffuse goiter, comparing those with and without coexisting ADs.

A retrospective cohort study was conducted using a large multi-institutional database. Adult patients undergoing total thyroidectomy with a diagnosis of thyrotoxicosis with diffuse goiter were identified and categorized based on the presence or absence of coexisting ADs. Propensity score matching (1:1) was performed to balance age, sex, race/ethnicity, and comorbidities. The primary outcomes assessed within 90 d postoperatively included hypocalcemia, dysphagia, recurrent laryngeal nerve injury, dysphonia, surgical site infection, hematoma, and calcitriol use. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated.

After propensity score matching, 1440 patients were included in each cohort. Baseline characteristics were well balanced between groups. Postoperative hypocalcemia occurred more frequently in patients with AD compared with those without AD (40.7% versus 34.9%; RR 1.17, CI 1.06-1.28). Rates of dysphagia, recurrent laryngeal nerve injury, dysphonia, and calcitriol use were similar between groups. Surgical site infection and hematoma were rare. In subgroup analyses by specific AD, vitiligo was associated with a higher risk of postoperative hypocalcemia (RR 1.54, 95% CI 1.04-2.29), whereas other autoimmune conditions demonstrated no statistically significant differences.

Patients with coexisting ADs undergoing total thyroidectomy for thyrotoxicosis with diffuse goiter are at increased risk of postoperative hypocalcemia.