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Surgical treatment for Graves’ disease Subtotal or Total Thyroidectomy?

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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  1. Surgical treatment for Graves’ diseaseSubtotal or Total Thyroidectomy? Dr. Chun-Fan KU Department of Surgery Pamela Youde Nethersole Eastern Hospital

  2. Treatment of Graves’ disease • Antithyroid medication • I131 ablation • Surgery

  3. Surveys of the European and American Thyroid Associations 1987,1990

  4. Antithyroid medication • Requires long treatment duration • Low permanent remission rates • Side effects

  5. I131 ablation • Pregnancy or lactation • Children • ?severe ophthalmopathy • ?large goitre • May requires >1 dose of I131 • Eventually developed hypothyroidism

  6. 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

  7. Subtotal vs Total Thyroidectomy • Simpler operation with lower complication rates --recurrent laryngeal nerve injury --parathyroid injury • Achieves a low recurrence rate while maintaining euthyroidism

  8. Subtotal vs Total Thyroidectomy • Complication rates --Palit TK. J. Surg. Res. 2000

  9. Thyroid function after Subtotal Thyroidectomy

  10. 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

  11. --Dominello A. Asian J of Surg. 2000

  12. Predictability thyroid function after Subtotal Thyroidectomy • TSH receptor antibody • Lymphoid infiltration • Antimicrosomal and other antithyroid antibodies

  13. 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

  14. Total Thyroidectomy • Comparable permanent complication rates • Predictable outcome in terms of thyroid function • No risk of recurrence • (need for life long thyroxine replacement)

  15. Conclusion • Surgeon’s preference • Patient’s choice between chance of recurrence and life long thyroxine replacement

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