SURGICAL-TREATMENT OF GRAVES-DISEASE - SUBTOTAL OR TOTAL THYROIDECTOMY

Background. The extent of thyroidectomy in Graves' disease is still co ntroversial. We compared the outcome of two groups of patients with Gr aves' disease who underwent total and subtotal thyroidectomy, respecti vely. Methods. One hundred forty patients were treated by subtotal (ST , n = 80) or total thyroidectomy (TT, n = 60) between 1988 and 1994 fo r a large goiter or recurrence of hyperthyroidism after antithyroid dr ugs. Surgical complications, relapse of hyperthyroidism, and serum lev els of antibodies were evaluated. Results. Thyroid-stimulating hormone receptor and thyroperoxidase antibodies significantly decreased in 44 of 60 and in 27 of 60, respectively, of TT patients and in 65 of 80 a nd 8 of 80, respectively, of ST patients. Thyroid-stimulating hormone antibody levels increased in three ST patients who had relapse of hype rthyroidism and in no TT patients: thyroperoxidase antibodies increase d in nine ST patients (four with relapse of hyperthyroidism) and in no TT patients. Vocal cord palsy occurred in two ST (2.5%) and in 1 TT ( 1.7%) patients; hypoparathyroidism occurred in three ST (3.8%) and in two (3.3%) TT patients. Conclusions. Total thyroidectomy does not pres ent more complications with respect to subtotal thyroidectomy, but it avoids the worsening of thyroid humoral autoimmunity and the relapse o f hyperthyroidism. Thus it could represent the treatment of choice in Graves' disease.