Surgical treatment of hyperthyroidism: A ten-year experience

Hyperthyroidism is treated either by antithyroid drugs, radioiodine (I-131) Or surgery. In Sweden, surgery is often performed in patients with large g oiter or severe hyperthyroidism with infiltrative endocrine ophthalmopathy. To evaluate indications and results of surgical treatment, data from 380 p atients operated on for hyperthyroidism at our department during 1986-1995 were analyzed. Twenty-six percent were referred for surgery because of fail ure of treatment with antithyroid drugs or I-131. Ninety-one percent were s ubjected to subtotal thyroidectomy with a median remnant weight of less tha n 2 g. In the remaining patients, total thyroidectomy was performed. Transi ent vocal cord affection occurred in 2.6%, none of which was permanent. Pro longed postoperative hypocalcemia occurred in 3.1%, and permanent hypoparat hyroidism in 1%. There was no difference in complication rate between subto tal or total thyroidectomy. Ln patients with Graves' disease, 5% worsened w ith regard to ophthalmopathy initially after surgery but later improved. Re current disease occurred in 2% of the patients, all of whom had undergone s ubtotal thyroideetomy. Surgery is not first-line therapy in all patients wi th hyperthyroidism. However, in experienced hands, surgery is a good therap eutic alternative that can be carried out with no mortality, few complicati ons, and, provided that a minimal remnant is left, very few recurrences.