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

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
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

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

predictability thyroid function after subtotal thyroidectomy
Predictability thyroid function after Subtotal Thyroidectomy
  • TSH receptor antibody
  • Lymphoid infiltration
  • Antimicrosomal and other antithyroid antibodies
slide14
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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