Surgical treatment for graves disease subtotal or total thyroidectomy
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Surgical treatment for Graves’ disease Subtotal or Total Thyroidectomy?. Dr. Chun-Fan KU Department of Surgery Pamela Youde Nethersole Eastern Hospital. Treatment of Graves’ disease. Antithyroid medication I 131 ablation Surgery.

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Surgical treatment for Graves’ disease Subtotal or Total Thyroidectomy?

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Surgical treatment for graves disease subtotal or total thyroidectomy

Surgical treatment for Graves’ diseaseSubtotal or Total Thyroidectomy?

Dr. Chun-Fan KU

Department of Surgery

Pamela Youde Nethersole Eastern Hospital


Treatment of graves disease

Treatment of Graves’ disease

  • Antithyroid medication

  • I131 ablation

  • Surgery


Surgical treatment for graves disease subtotal or total thyroidectomy

Surveys of the European and American Thyroid Associations 1987,1990


Antithyroid medication

Antithyroid medication

  • Requires long treatment duration

  • Low permanent remission rates

  • Side effects


I 131 ablation

I131 ablation

  • Pregnancy or lactation

  • Children

  • ?severe ophthalmopathy

  • ?large goitre

  • May requires >1 dose of I131

  • Eventually developed hypothyroidism


Surgical indications

Surgical indications

--Suspect malignancy

--Desiring pregnancy

--Local compression

--Fear of irridation

--Children

  • --Poorly compliant patients

  • --Cosmetic

  • --Severe Graves’ ophthalmopathy

  • --Need of rapid symptom control

--Roe SM J Am Coll Surg 2001


Subtotal vs total thyroidectomy

Subtotal vs Total Thyroidectomy

  • Simpler operation with lower complication rates

    --recurrent laryngeal nerve injury

    --parathyroid injury

  • Achieves a low recurrence rate

    while maintaining euthyroidism


Subtotal vs total thyroidectomy1

Subtotal vs Total Thyroidectomy

  • Complication rates

--Palit TK. J. Surg. Res. 2000


Surgical treatment for graves disease subtotal or total thyroidectomy

Thyroid function after Subtotal Thyroidectomy


Instability of thyroid function after subtotal thyroidectomy

Instability of thyroid function after Subtotal Thyroidectomy

  • 79% of patients change thyroid status during follow up period of 8-12yrs

--Kuma K. Am J Med Sci 1991


Surgical treatment for graves disease subtotal or total thyroidectomy

--Dominello A. Asian J of Surg. 2000


Predictability thyroid function after subtotal thyroidectomy

Predictability thyroid function after Subtotal Thyroidectomy

  • TSH receptor antibody

  • Lymphoid infiltration

  • Antimicrosomal and other antithyroid antibodies


Surgical treatment for graves disease subtotal or total thyroidectomy

  • Remnant size

    8.9% decline in the rate of hypothyroidism for each gram of thyroid remnant

    --Palit TK. J. Surg. Res. 2000

--Hermann M. Surgery. 1998


Total thyroidectomy

Total Thyroidectomy

  • Comparable permanent complication rates

  • Predictable outcome in terms of thyroid function

  • No risk of recurrence

  • (need for life long thyroxine replacement)


Conclusion

Conclusion

  • Surgeon’s preference

  • Patient’s choice between chance of recurrence and life long thyroxine replacement


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