SURGERY STILL HAS A ROLE IN GRAVES HYPERTHYROIDISM

Background. A recent survey of American thyroidologists defining their management of a 43-year-old woman with hyperthyroid Graves' disease a nd a thyroid weighting 40 to 50 grams revealed that 69% recommended io dine 131 therapy, 30% prolonged antithyroid drug therapy, and only 1% operation. If the patient was younger or had a larger thyroid, 4% to 7 % of the respondents recommended operation. Methods. In our clinic we often recommend operation for young adult patients with large goiters who have had recurrent hyperthyroidism after antithyroid drug (ATD) th erapy, have allergic reactions to ATD, are not compliant, are ATD fail ures, or refuse I-131 therapy. Thus operation for Graves' disease is r ecommended more frequently in our clinic than this survey indicates. F rom 1980 to 1992, 81 patients with Graves' disease (15 men and 66 wome n; mean age, 30 years) underwent a subtotal thyroidectomy. Patients ha d been pretreated with antithyroid drugs and saturated solution of pot assium iodide, and thyroid conditions were normal at the time of opera tion. All patients underwent subtotal thyroidectomy by one surgeon and 3 to 5 grams of thyroid were left on each side. Results. There was no permanent recurrent nerve damage or hypoparathyroidism. Hyperthyroidi sm recurred in one patient (1.2%). Hypothyroidism developed in 59% of our patients, 77% within 1 year after operation, which was easily mana ged with replacement doses of levothyroxine. Ophthalmopathy had not de veloped or progressed in any patient, as has recently been suggested t o occur after I-131 therapy of Graves' disease. Conclusions. Because o ur patients are almost always hospitalized for no more than 24 to 36 h ours, have had no complications except for hypothyroidism, have had th eir disease abruptly terminated, did not have ophthalmopathy, required far fewer physician visits and laboratory tests compared with patient s treated with ATD or I-131 surgery remains a reasonable approach to t he management of Graves' disease.