Total thyroidectomy safe, effective for Graves’ disease
Surgical removal of the thyroid in experienced hands may be considered a safe, effective first option in the treatment of Graves’ disease, results of a new study suggest.
“Surgery is an underutilized option for patients with Graves’,” Rebecca Sippel, MD, assistant professor of surgery at the University of Wisconsin School of Medicine and Public Health, said in a press release. “Historically, patients have not been offered the option of surgery due to concerns about complications. Our study shows that the rate of permanent complications is very low.”
The study followed 58 patients who had a total or partial thyroidectomy at the University of Wisconsin Hospital and Clinics between 1994 and 2008. Of the 58 surgeries, 32 were total thyroidectomy, 24 were subtotal/lobectomy and two were completion thyroidectomy. Most of the patients had also tried medical or radioactive iodine (RAI) therapy, but those approaches failed to control the disease.
Persistent disease despite medical therapy was the most commonly cited reason by patients undergoing thyroid surgery, followed by patient preference, multinodular goiter/cold nodules, failed RAI therapy and ophthalmopathy. Among patients who failed prior RAI therapy, the only factor predictive of failure was disease severity, which was demonstrated by an elevated initial free thyroxine value (11.8 ng/dL).
The researchers found that patients who underwent total thyroidectomy had a very low complication rate. Additionally, there was no difference in overall complication rates between patients based on surgical procedure, preoperative RAI treatment or gland size. Recurrence occurred in 6% of patients who underwent subtotal thyroidectomy and no patients who underwent total thyroidectomy. More than 10% of patients experienced transient symptomatic hypocalcemia and one patient experienced symptomatic hypocalcemia that lasted more than 6 months. No permanent recurrent laryngeal nerve injuries were reported.
“Surgery is not right for everyone, but if patients are presented with all the options, many would choose surgery as a first-line option,” Sippel said in the release. “Surgery is the most rapid method for obtaining definitive control of their disease.”
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