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Modified subtotal thyroidectomy for Graves' disease: a two-institution study.

E I Bradley, R D Liechty

    Surgery
    |December 1, 1983
    PubMed
    Summary
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    A modified subtotal thyroidectomy (MST) significantly reduces hypothyroidism after Graves' disease surgery. This technique preserves thyroid function, achieving euthyroidism in 92% of patients and improving surgical outcomes.

    Area of Science:

    • Endocrinology
    • Surgical Oncology
    • Thyroid Surgery

    Background:

    • Graves' disease is a common cause of hyperthyroidism.
    • Conventional subtotal thyroidectomy (CST) for Graves' disease is associated with high rates of postoperative hypothyroidism.
    • Minimizing remnant thyroid tissue in CST can lead to hypothyroidism, while leaving too much risks recurrence.

    Purpose of the Study:

    • To evaluate a modified subtotal thyroidectomy (MST) technique designed to decrease postoperative hypothyroidism after Graves' disease surgery.
    • To compare the functional outcomes and recurrence rates of MST with conventional subtotal thyroidectomy (CST).

    Main Methods:

    • A prospective study involving 107 patients undergoing MST at two institutions.
    • MST involves leaving a precisely measured 5 gm thyroid remnant and an intact inferior thyroid artery on each side.

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  • Patients were followed for over 2 years with serial clinical and thyroid function tests.

    • Main Results:

    • Euthyroidism was achieved in 92% of patients following MST.
    • Postoperative hypothyroidism occurred in only 2% of MST patients, a significant reduction compared to CST (40%-75%).
    • Recurrent hyperthyroidism was observed in 6% of MST patients, comparable to CST rates.

    Conclusions:

    • Enlarging the total remnant size to 10 gm in MST significantly improves long-term functional results without increasing recurrence risk.
    • MST offers superior functional outcomes compared to radioiodine treatment for Graves' disease.
    • The results support renewed interest in surgical management for Graves' disease using the MST technique.