[Morbidity after subtotal and total thyroidectomy in patients with Graves' disease: the basis for decision-making regarding surgical indication and extent of resection].

Compared to radioiodine therapy the surgical treatment of Graves' disease aims to combine high therapeutic efficacy with low morbidity. According to the literature the risk for complications concerning recurrent laryngeal nerve paralysis and hypocalcaemia is lower after subtotal (0.6% and 0.9% respectively) than after total thyroidectomy (1.1% and 1.7% respectively). In contrast, the rate of persistent or recurrent thyrotoxicosis (3.2% and zero respectively) and the rate of worsening or newly developing endocrine ophthalmopathy is higher after subtotal resection than after total thyroidectomy (8% and 2% respectively). On the basis of these data, total thyroidectomy performed by an experienced surgeon is recommended in the case of complicated Graves' disease and in special situations (e.g. pregnancy and breastfeeding, suspected or proven concomitant thyroid malignancy, severe side effects of antithyroid drug treatment). Subtotal thyroidectomy should be reserved for patients with low activity of Graves' goitre, where radioiodine treatment has a similar effect but without the risks associated with surgery.