ARTICOLI ORIGINALI   

Chirurgia 2015 February;28(1):7-12

Copyright © 2015 EDIZIONI MINERVA MEDICA

lingua: Inglese

Surgical approach to Graves’ disease: our results in Iran

Mehrabibahar M., Asadi M., Nouri M., Majidi S.

Surgical Oncology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

AIM: The two most frequently performed operations for surgical treatment of Graves’ disease (GD) are total thyroidectomy (TT) and subtotal thyroidectomy (ST). Debate persists regarding the optimal method of thyroidectomy for GD regarding their outcomes and complications. Investigations about this issue are limited in Asian countries. The aim of the current study was to evaluate outcomes of TT versus ST for GD in Iran.
METHODS: A retrospective study on 75 consecutive patients with GD who underwent total or subtotal thyroidectomy between 1998 and 2007 was conducted. We noted all significant postoperative complications such as hypothyroidism, recurrent hyperthyroidism, transient and permanent hypoparathyroidism, transient and permanent recurrent laryngeal nerve (RLN) palsy, hematoma and wound infection. Also, early and late outcomes of both procedures were recorded.
RESULTS: There were 41 and 34 patients in ST and TT groups, respectively. Mean age was 38.57±8.75 years (range 22-65 years) and there were 61 women (81.33%) among them. During follow-up, all patients in TT group developed post operative hypothyroidism and no recurrence was found in this group. In ST group, 15 (34.88%) patients achieved euthyroidism and remained stable, 8 (18.60%) patients developed recurrent hyperthyroidism within 3 months after operation and 18 (43.90%) cases developed postoperative hypothyroidism. None of the patients in both groups developed permanent RLN palsy or permanent hypocalcemia. Transient hypocalcemia occurred in 33 patients (16 of 43 patients in ST group and 17 of 31 in TT group). Transient RLN palsy occurred in 3 patients (2 patients in ST group and 1 patient in TT group). Deep hematoma occurred in 1 patient of ST group and superficial hematoma occurred in 2 patients of TT group. Postoperative compilations were not significantly different between the groups.
CONCLUSION: Both TT and ST are safe procedures regarding postoperative complications. Postoperative thyroid function after ST is unpredictable while TT is an effective and safe surgical treatment for GD that provides an immediate and definitive treatment, with low morbidity, mortality, and recurrence rates. Our investigation indicated that regarding TT outcomes and complications and socio-economic condition of Iran, current accepted guidelines that advocated superiority of TT in western countries is also true in this country.