The efficacy of thyroidectomy for Graves' disease: A meta-analysis

Background. Surgery for Graves' disease was largely replaced in the mid-190 0s by radioiodine and antithyroid drugs, due to the belief that they were m ore safe and effective. Since then, thyroid surgery has improved with preop erative drug therapy and modern operative techniques. Recent clinical studi es of thyroidectomy for Graves' disease may not reflect outcomes accurately because of small sample size, especially when estimating ideal thyroid rem nant size. The purpose of this study was to combine modern clinical trials and use meta-analysis to determine the overall efficacy of both total (TT) and subtotal thyroidectomy (ST) for Graves' disease, compare thyroid functi on and complications rates of TT and ST, and determine ideal thyroid remnan t size. Methods. Meta-analysis was performed on published studies in which patients underwent either TT or ST for Graves' disease. Meta-analysis was performed by weighted least-squares linear regression. P < 0.05 was considered signi ficant. Results. There were 35 studies comprising 7241 patients. Mean follow-up was 5.6 years. Overall, persistent or recurrent hyperthyroidism occurred in 7. 2% of patients. TT was performed on 538 patients and hypothyroidism occurre d in all cases. ST was performed in 6703 patients, 59.7% of whom achieved e uthyroidism, 25.6% became hypothyroid, and 7.9% had either persistent or re current hyperthyroidism. Permanent recurrent laryngeal nerve injury occurre d in 0.9% of TT patients and 0.7% of ST patients (P = NS). Permanent hypopa rathyroidism occurred in 1.6% of TT patients and 1.0% of ST patients (P = N S). There was an 8.9% decrease in hypothyroidism and 6.9% increase in euthy roidism for each gram of thyroid remnant (P < 0.0001 each). Conclusions. Overall, thyroidectomy successfully treated hyperthyroidism in 92% of patients with Graves' disease. There were no cases of hyperthyroidi sm following TT. ST achieved a euthyroid state in almost 60% of patients wi th an 8% rate of persistent or recurrent hyperthyroidism. There was no sign ificant difference in complication rates between TT and ST. (C) 2000 Academ ic Press.