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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Articles in this Issue were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence. Articles are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Lithuanian Medical Association, Lithuanian University of Health Sciences, and Vilnius University.
Open AccessArticle

Surgical treatment of Graves’ disease: Subtotal thyroidectomy might still be the preferred option

1
Department of Surgery, University of Tartu, Tartu, Estonia
2
North Estonian Regional Hospital, Tallinn, Estonia
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Author to whom correspondence should be addressed.
Medicina 2008, 44(1), 22; https://doi.org/10.3390/medicina44010004
Received: 19 February 2007 / Accepted: 17 October 2007 / Published: 22 October 2007
Objective. The aim of this prospective study was to report our results after thyroidectomy for Graves’ disease. In addition, the relationship between the thyroid remnant and postoperative thyroid function was studied.
Material and methods
. Forty-nine consecutive patients were operated on for Graves’ disease. The indications for surgery were persistent or recurrent hyperthyroidism after medical treatment in 34 patients (69.4%), mechanical symptoms due to a large goiter in 7 (14.3%), increased ophthalmopathy in 7 (14.3%), and allergy to antithyroid medications in 1 patient (2.0%). Total thyroidectomy (TT) was performed in 28 and subtotal thyroidectomy (STT) in 21 patients. Followup lasted 24 to 70 months.
Results. There was no statistically significant difference in the rate of postoperative complications comparing TT and STT. The patients who underwent TT had no recurrence during a mean follow-up of 47 months. After STT, with the mean weight of the thyroid remnant 3.0±1.0 g, there was no relapse of Graves’ disease during a mean follow-up of 52 months. After STT, postoperative hypothyroidism developed in 14 patients (66.7%); 7 patients (33.3%) remained euthyroid during follow-up. Comparison of the euthyroid patients and the hypothyroid patients revealed no difference in the weight of the remnant (3.3 g vs. 2.8 g), but a statistically significant difference occurred in the weight of the resected gland (61.0 g vs. 94.4 g, P=0.026) and in the proportion of the remnant (5.6% vs. 3.3%, P=0.030).
Conclusions
. Both TT and STT are safe procedures regarding postoperative complication rate. STT with the thyroid remnant of about 3 g allows to permanently cure hyperthyroidism ensuring the euthyroid state in a significant proportion of patients. Postoperative thyroid function after STT is best predicted by the proportion of the remnant.
Keywords: hyperthyroidism; Graves’ disease; total thyroidectomy; subtotal thyroidectomy; amount of the thyroid remnant hyperthyroidism; Graves’ disease; total thyroidectomy; subtotal thyroidectomy; amount of the thyroid remnant
MDPI and ACS Style

Lepner, U.; Seire, I.; Palmiste, V.; Kirsimägi, Ü. Surgical treatment of Graves’ disease: Subtotal thyroidectomy might still be the preferred option. Medicina 2008, 44, 22.

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