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Surgery still has a role in Graves' hyperthyroidism

N A Patwardhan¹, M Moront, S Rao

¹Department of Surgery and Pathology, University of Massachusetts Medical Center, Worcester 01655.

|December 1, 1993

Summary

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Surgery offers a safe and effective treatment for Graves' disease, leading to abrupt disease termination with minimal complications. This approach requires fewer follow-ups compared to antithyroid drugs or iodine 131 therapy.

Area of Science:

Endocrinology
Surgical Management
Thyroid Disorders

Background:

Graves' disease is a common cause of hyperthyroidism.
Management strategies vary, with a survey indicating a preference for iodine 131 or antithyroid drug therapy over surgery.
Surgical intervention is often reserved for specific patient populations or treatment failures.

Purpose of the Study:

To evaluate the efficacy and safety of subtotal thyroidectomy for Graves' disease in a high-volume clinic.
To compare surgical outcomes with non-surgical management options.

Main Methods:

A retrospective review of 81 patients with Graves' disease who underwent subtotal thyroidectomy between 1980 and 1992.
Patients received preoperative treatment with antithyroid drugs and potassium iodide.

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A consistent surgical technique was employed, leaving 3-5 grams of thyroid tissue on each side.

Main Results:

No permanent recurrent laryngeal nerve damage or hypoparathyroidism occurred.
Hyperthyroidism recurrence was low (1.2%).
Postoperative hypothyroidism developed in 59% of patients, managed effectively with levothyroxine. No new or progressive ophthalmopathy was observed.

Conclusions:

Subtotal thyroidectomy is a safe and effective treatment for Graves' disease, offering abrupt disease resolution.
The procedure is associated with minimal complications, short hospital stays, and fewer long-term physician visits and tests compared to other modalities.
Surgery represents a viable management option for Graves' disease, particularly in selected patient groups.