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ABSTRACT
BACKGROUND: Graves' disease is the commonest cause of hyperthyroidism. For patients with Graves' hyperthyroidism, antithyroid medication is the most common first-line treatment option. Radioiodine and surgery are reserved for specific indications. Subtotal thyroidectomy was the preferred surgical approach historically, but total thyroidectomy has been the established procedure of choice for the last 20 years.
AIM: To describe indications and outcomes of total thyroidectomy for Graves' disease in a large New Zealand endocrine surgery unit, and to compare these results to international studies
METHODS: We analysed a prospectively collected database to describe the indications and outcomes of surgery for Graves' disease between December 2001 and January 2021.
RESULTS: Among 64 patients who underwent total thyroidectomy at our tertiary centre for Graves' hyperthyroidism, Graves' ophthalmopathy and patient preference/aversion to radioactive iodine were the most common indications for surgery. Total thyroidectomy resulted in long-term control of thyrotoxicosis in all patients. There were no incidences of recurrent laryngeal nerve injury. One patient (1.6%) suffered permanent hypoparathyroidism.
CONCLUSION: Total thyroidectomy is a safe and effective treatment for Graves' disease. In our population, total thyroidectomy functions as a second-line treatment for Graves' disease.
Graves' disease, an autoimmune condition characterised by the presence of autoantibodies against the thyroid stimulating hormone (TSH) receptor, is the most common cause of hyperthyroidism.1 Graves' disease is more common in women, with a ratio of 5:1.1 Typical symptoms include clinical and biochemical evidence of hyperthyroidism, Graves' ophthalmopathy and goitre. Management options include biochemical control with antithyroid drugs (ATD), thyroid ablation with radioactive iodine (RAI) and thyroid surgery2. ATD treatment is commonly used as the firstline treatment option in order to induce remission, with RAI the preferred treatment option in patients who fail with this approach. Surgery is an alternative treatment approach that may be appropriate in a smaller number of patients.3 Traditionally, indications for surgery have included large goitre with compressive symptoms, pregnancy or planning for pregnancy, severe ophthalmopathy, young age, failure of RAI treatment, suspicion of malignancy, inability to tolerate RAI (eg, need to care for young children), intolerance of antithyroid drugs, thyroid storm and patient preference.2
Options for surgery have included bilateral subtotal thyroidectomy, Dunhill procedure (unilateral lobectomy and contralateral subtotal lobectomy) and total or near-total thyroidectomy.4 For most of the twentieth century,...