Open Access, Peer-reviewed
pISSN 2288-6575
eISSN 2288-6796
    J Korean Surg Soc. 2009 Aug;77(2):82-87. Korean.
    Published online Aug 04, 2009.
    https://doi.org/10.4174/jkss.2009.77.2.82
    Copyright © 2009 The Korean Surgical Society
    Original Article

    Surgical Treatment of Graves' Disease: Comparison between Total Thyroidectomy and Subtotal Thyroidectomy

    Tae-Yon Sung, M.D., Yon Seon Kim, M.D., Sook Hyun Lee, M.D.,1 Jong Ho Yoon, M.D. and Suk-Joon Hong, M.D.
      • Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea.
      • 1Department of Surgery, Kwandong University College of Medical Science, Gangneung, Korea.
    • Corresponding author (Email: sjhong2@amc.seoul.kr )
    Received March 25, 2009; Accepted June 15, 2009.

    Abstract

    Purpose

    Subtotal thyroidectomy has been the standard operation for Graves' disease in achieving a favorable outcome in recovery of euthyroid state. However, the postoperative outcomes following subtotal thyroidectomy differ by surgeon and postoperative thyroid dysfunctions develop as time passes. Here, we have studied the validity of total thyroidectomy for Graves' disease patients, with a comparison to subtotal thyroidectomy.

    Methods

    A total of 299 patients with Graves' disease underwent thyroid operation consecutively in Asan Medical Center, Seoul, Korea from December 1995 to December 2005. Among them, 241 cases had subtotal thyroidectomy and 43 had total thyroidectomy. The subtotal thyroidectomy cases were divided into 3 groups according to estimated remnant thyroid; <4 g, 4≤~<6 g and ≥6 g. Also, according to postoperative thyroid function, the patients were divided into euthyroid, hypothyroidism and hyperthyroidism groups. The postoperative changes of thyroid function, postoperative complications and hospital days were analyzed.

    Results

    In subtotal thyroidectomy, postoperative thyroid function showed euthyroid in 25 (10.4%), hypothyroidism 206 (85.5%) and hyperthyroidism 10 (4.1%). However, total thyroidectomy showed no persistent hyperthyroidism or recurrence. The postoperative thyroid function state changed in 24 patients out of 148 who had more than 2 years postoperative follow-up. Hyper-functional changes developed with higher rates (Hypo-6 vs. hyper-18). The postoperative complication rate was higher in subtotal thyroidectomy including bleeding, hoarseness and hypocalcemia.

    Conclusion

    In our study, the patients showing normal thyroid function after subtotal thyroidectomy were very limited and thyroid dysfunction developed continuously with time lapse, especially towards hyperthyroid state. Therefore, we suggest that total thyroidectomy should be considered as a treatment option in Graves' disease.

    Keywords
    Graves' disease; Subtotal thyroidectomy; Total thyroidectomy; Thyroid function

    Figures

    Fig. 1
    Recurrence after subtotal thyroidectomy. Pattern of recurrence after subtotal thyroidectomy shows that recurrence continuously develops as time passes.

    Fig. 2
    Pattern of hypothyroidism change after subtotal thyroidectomy. Pattern of hypothyroidism change after subtotal thyroidectomy shows that hypo-functional change was developed within 1 year after the operation and only few newly developed hypothyroidism after 1 year.

    Tables

    Table 1
    Overall postoperative thyroid function after subtotal thyroidectomy (n=241)

    Table 2
    Postoperative thyroid function according to estimated remnant thyroid after subtotal thyroidectomy

    Table 3
    Postoperative thyroid function changes after subtotal thyroidectomy according to time interval (n=148)

    Table 4
    Comparison of postoperative complications between subtotal thyroidectomy and total thyroidectomy

    Table 5
    Comparison of hospital days between subtotal thyroidectomy and total thyroidectomy

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    MeSH Terms
    Follow-Up Studies
    Graves Disease
    Hemorrhage
    Hoarseness
    Humans
    Hyperthyroidism
    Hypocalcemia
    Hypothyroidism
    Korea
    Postoperative Complications
    Recurrence
    Thyroid Gland
    Thyroidectomy
    Metrics
    Share
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    Tables
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