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[Outcome of surgery in 300 cases of hyperthyroidism, including 40 with cardiotoxicity (author's transl)]
Insights
Subtotal thyroidectomy is effective for Graves
Area of Science:
- Endocrinology
- Surgical Oncology
Context:
- Subtotal thyroidectomy is a surgical intervention for hyperthyroidism.
- Graves' disease, solitary toxic goiter, and multinodular toxic goiter are common causes of hyperthyroidism.
Purpose:
- To evaluate the efficacy and safety of subtotal thyroidectomy for hyperthyroidism.
- To assess the impact of cardiotoxicity on post-operative outcomes.
- To determine the long-term results of subtotal thyroidectomy, including relapse and hypothyroidism rates.
Summary:
- A study of 300 patients undergoing subtotal thyroidectomy found satisfactory long-term results for Graves' disease, solitary toxic goiter, and multinodular toxic goiter.
- Preserving approximately 6 grams of thyroid tissue, measured by comparative double-weighing, minimized relapses (2%) and permanent hypothyroidism (18% in Graves' disease patients within 3 years).
- Immediate post-operative complications were reduced with propranolol, neuroleptanalgesia, and hypothermia in severe cases. Cardiotoxicity did not increase complications or hypothyroidism risk.
Impact:
- Subtotal thyroidectomy demonstrates good long-term outcomes for hyperthyroid conditions.
- The precise measurement of preserved thyroid tissue is crucial for successful surgical outcomes.
- These findings support broader surgical indications for treating hyperthyroidism.
Abstract:
Of 300 patients who underwent subtotal thyroidectomy, 204 had Graves' disease, 52 solitary toxic goiter and 39 multinodular toxic goiter. Cardiotoxicity was present in 40 cases. Immediate post-operative complications could be avoided by the use of propranolol, neuroleptanalgesia and, in a few very severe cases, hypothermia. Long term results were satisfactory, even after surgery for diffuse hyperthyroidism. Relapses occurred in only 2%, and permanent hypothyroidsm developed within 3 years in only 18% of patients with Graves' disease, this being due to the preservation of 6 grams of thyroid tissue systematically measured by comparative double-weighing. The authors insist on the value of this technique, guess evaluation being unreliable. Cardiotoxicity did not increase post-operative complications, nor the risk of permanent hypothyroidism. The good results obtained should encourage wider surgical indications for the treatment of Graves' disease, solitary toxic goiter or multinodular toxic goiter.