Value of total thyroidectomy for Graves' disease in eliminating the risk of recurrence and malignancy: retrospective database analysis of 574 Saudi Arabian patients in 10 years with 2 years follow up
DOI:
https://doi.org/10.18203/issn.2454-5929.ijohns20160061Keywords:
Thyroidectomy, Grave's disease, Hyperthyroidism, Hypocalemia, Recurrent laryngeal nerve injury, RecurrenceAbstract
Background: Graves' disease is an autoimmune disease that affects the thyroid gland and frequently results in hyperthyroidism and an enlarged thyroid. Treatment of Graves' disease includes antithyroid drugs, radioiodine (radioactive iodine I-131), and thyroidectomy, either total, or subtotal excision. In this paper, we aim to analyse the outcome of thyroidectomy performed on patients affected by Graves' disease in Medina – Saudi Arabia, and evaluate if thyroidectomy should be considered the first treatment option for all patients with Graves' disease.
Methods: A retrospective database analysis of the surgical treatment outcome of 574 Saudi Arabian patients who were affected with Graves' disease between January 2003 and December 2012 was done. The computerized database medical records were reviewed and analysed for preoperative, intraoperative, and postoperative factors.
Results: 194 (33.8%) patients were males, and 380 (66.2%) were females. The average age of patients was 44 ± 2 years. 154 (26.8%) had subtotal thyroidectomy, and 420 (73.2%) had total thyroidectomy performed. There was (0%) recurrent laryngeal nerve injury, and (0%) intraoperative complication were recorded. With a follow up time of 2 years, 7 (1.22%) patients developed recurrent disease (all in subtotal thyroidectomy group). There were no recurrences in the total thyroidectomy patients, and 11 (1.9%) patients were found in histopathology to have papillary thyroid cancer (all in total thyroidectomy group).
Conclusions: We conclude that total thyroidectomy is a safe and effective treatment modality for Graves' disease that offers rapid and long-lasting results, in addition to eliminating the risk of recurrence and malignancy. It should be offered to all confirmed Graves' disease patients during counselling.
References
Brent, Gregory A. Clinical practice. Graves' disease. The New England Journal of Medicine. 2008;358(24):2594–605.
Boostrom S, Richards ML. Total thyroidectomy is the preferred treatment for patients with Graves' disease and a thyroid nodule. Otolaryngol Head Neck Surg. 2007;136(2):278–81.
Menconi F, Marcocci C, Marinò M. Diagnosis and classification of Graves' disease. Autoimmunity reviews. 2014;13(4-5):398–402.
Homsanit M, Sriussadaporn S, Vannasaeng S, Peerapatdit T, Nitiyanant W, Vichayanrat A. Efficacy of single daily dosage of methimazole vs. propylthiouracil in the induction of euthyroidism. Clin. Endocrinol. (Oxf). 2001;54(3):385–90.
Genovese BM, Noureldine SI, Gleeson EM, Tufano RP, Kandil E. What is the best definitive treatment for Graves' disease? A systematic review of the existing literature. Annals of Surgical Oncology (review). 2013;20(2):660–7.
Lal G, Ituarte P, Kebebew E, Siperstein A, Duh QY, Clark OH. Should total thyroidectomy become the preferred procedure for surgical management of Graves’ Disease?. Thyroid. 2005;15(6):569–74.
Alsanea O, Clark OH. Treatment of Graves' disease: the advantages of surgery. Endocrinol Metab Clin North Am. 2000;29(2):321–37.
Leech NJ, Dayan CM. Controversies in the management of Graves' disease. Clin Endocrinol (Oxf). 1998;49(3):273–80.
Acharyya BN, Fried MP. Assessment of the morbidity and complications of total thyroidectomy. Arch Otolaryngol Head Neck Surg. 2002;128(4):389–92.
Jortso E, Lennquist S, Lundstrom B, Smeds S. The influence of remnant size, antithyroid antibodies, thyroid morphology and lymphocyte infiltration on thyroid function after subtotal resection for hyperthyroidism. World J Surg. 1987;11:365-71.
Behar R, Arganini M, Wu TC, McCormick M, Straus FH 2nd, DeGroot LJ et al. Graves' disease and thyroid cancer. Surgery. 1986;100(6):1121-7.
Schussler-Fiorenza CM, Bruns CM, Chen H: The surgical management of Graves’ disease. J Surg Res. 2006;133(2):207–14.
Pattou F, Combemale F, Fabre S. Hypocalcaemia following thyroid surgery incidence and prediction of outcome. World J Surg. 1998;22:718-24.
Ku CF, Lo CY, Chan WF. Total thyroidectomy replaces subtotal thyroidectomy as the preferred surgical treatment for Graves disease. ANZ J Surg. 2005;75:528-31.
Thompson NW, Reeve T. Complications of thyroid surgery: How to avoid them, how to manage them, and observations on their possible effect on the whole patient. World J Surg. 2000;24:971–5.
Kraimps JL, Bouin-Pineau MH, Mathonnet M, De Calan L, Ronceray J, Visset J. Multicenter study of thyroid nodules in patients with Graves’s disease. Br J Surg. 2000;87:1111-3.
Ralls PW, Mayekawa DS, Lee KP, Colletti PM, Fadin DR, Boswell WD et al. Color-flow Doppler sonography in GD: ‘thyroid inferno’ Am J Roentgenol. 1988;150:781–4.
Arslan H, Unal O, Algün E, Harma M, Sakarya ME. Power Doppler sonography in the diagnosis of Graves> disease. Eur J Ultrasound. 2000;11:117-22.
Cappelli C, Pirola I, De Martino E, Agosti B, Delbarba A, Castellano M, et al. The role of imaging in Graves> disease. Euro J Rad. 2008;65:99–103.
Kumar K, Pasupuleti V, Jayaraman M, Abhyuday V, Rayudu R, Modi K. Role of thyroid Doppler in differerntial diagnosis of thyrotoxicosis. Endocrin Pract. 2009;15:6–9.
