Thyroidectomy for selected patients with thyrotoxicosis

Objective: To examine the indications for operation and the frequency, effi cacy, and outcome of surgical therapy for thyrotoxicosis. Methods: The medical records of all patients who underwent thyroidectomy be tween 1990 and 1998 were reviewed. Operative indications, laboratory evalua tions, extent of thyroidectomy, pathologic findings, and morbidity and mort ality were determined for patients with thyrotoxicosis. Results: Of the 347 patients who underwent thyroidectomy, 54 (16%) had thyr otoxicosis, secondary to Graves' disease (32 patients), toxic multinodular goiter (18 patients), thyroiditis (2 patients), or amiodarone (2 patients). The indications for operation were compressive symptoms or substernal exte nsion or both (35 patients), patient preference (12 patients), thyrotoxicos is (4 patients), or a dominant nodule (3 patients). Most patients received pharmacological preparation, followed by total (32 patients), near-total (1 3 patients), subtotal(8 patients), or unilateral (1 patient) thyroidectomy. The initial 8 patients with Graves' disease underwent subtotal thyroidecto my, and after a mean 28-month follow-up, 1 was euthyroid; 2, hyperthyroid; and 5, hypothyroid. Associated carcinoma was present in 4 (7%) of the 54 pa tients. Symptomatic hypocalcemia occurred in 10 patients (19%), with a mean free thyroxine level of 60.49 +/- 16.09 pmol/L vs 40.41+/-19.56 pmol/L (4. 70 +/- 1.25 ng/dL vs 3.14+/-1.52 ng/dL) in 25 patients (46%) with asymptoma tic hypocalcemia (P<.05). Vocal cord paresis and a hematoma requiring opera tive evacuation occurred in 1 patient each. There was 1 mortality in a pati ent with amiodarone-induced thyrotoxicosis. Conclusions: Massive thyroid enlargement with compressive symptoms, a domin ant nodule. and patient preference are indications for surgical treatment o f thyrotoxicosis. Near-total or total thyroidectomy is safe and more effect ive than subtotal thyroidectomy in preventing recurrence and should be cons idered in must patients referred for surgical treatment of thyrotoxicosis. Transient postoperative hypocalcemia is common and is related to the severi ty. of thyrotoxicosis.