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’ diseaseSubtotal or Total Thyroidectomy?

Dr. Chun-Fan KU

Department of Surgery

Pamela Youde Nethersole Eastern Hospital


Treatment of Graves’ disease

  • Antithyroid medication

  • I131 ablation

  • Surgery


Surveys of the European and American Thyroid Associations 1987,1990


Antithyroid medication

  • Requires long treatment duration

  • Low permanent remission rates

  • Side effects


I131 ablation

  • Pregnancy or lactation

  • Children

  • ?severe ophthalmopathy

  • ?large goitre

  • May requires >1 dose of I131

  • Eventually developed hypothyroidism


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

  • Simpler operation with lower complication rates

    --recurrent laryngeal nerve injury

    --parathyroid injury

  • Achieves a low recurrence rate

    while maintaining euthyroidism


Subtotal vs Total Thyroidectomy

  • Complication rates

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


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


--Dominello A. Asian J of Surg. 2000


Predictability thyroid function after Subtotal Thyroidectomy

  • TSH receptor antibody

  • Lymphoid infiltration

  • Antimicrosomal and other antithyroid antibodies


  • 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

  • Comparable permanent complication rates

  • Predictable outcome in terms of thyroid function

  • No risk of recurrence

  • (need for life long thyroxine replacement)


Conclusion

  • Surgeon’s preference

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


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