The European journal of surgery = Acta chirurgica · 1997
Should the primary treatment of hyperthyroidism be surgical?
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Linos D A, Karakitsos D, Papademetriou J
Аннотация
OBJECTIVE: To review the results of the surgical treatment of all types of hyperthyroidism (Graves' disease, toxic nodular goitre, and toxic solitary adenoma).
DESIGN: Retrospective study.
SETTING: University hospital and private hospital, Greece.
SUBJECTS: 400 Consecutive patients who were operated on between 1982 and 1991.
INTERVENTION: Near total/total thyroidectomy in 226 patients with toxic nodular goitre and 87 patients with Graves' disease. Subtotal thyroidectomy in 25 patients with Graves' disease (early period of the study); lobectomy with resection of the isthmus of the thyroid in 62 patients with a solitary toxic adenoma.
MAIN OUTCOME MEASURES: Mortality, morbidity and patients' self assessment of the results of operation (symptoms, scar, ophthalmopathy).
RESULTS: There was no mortality. Morbidity included 2 postoperative bleeds that required reoperation; 2 patients developed permanent unilateral vocal cord paralysis and 2 had permanent hypoparathyroidism. In 27 of the 400 patients (7%) a thyroid carcinoma was found in the resected specimen. No patient had persistent or recurrent hyperthyroidism 2 to 10 years after operation. Of the 49 patients with Graves' disease and opthalmopathy at the time of operation, 35 (71%) reported improvement in their ophthalmopathy and 14 (29%) reported no improvement. No patient had worsening of their exophthalmos; 388 (97%) were satisfied with their incision; and 360 (90%) reported a significant improvement in their preoperative symptoms (tachycardia, weakness, anxiety, and pressure in the neck).
CONCLUSIONS: We suggest that the primary treatment of all types of hyperthyroidism should be surgical.
DESIGN: Retrospective study.
SETTING: University hospital and private hospital, Greece.
SUBJECTS: 400 Consecutive patients who were operated on between 1982 and 1991.
INTERVENTION: Near total/total thyroidectomy in 226 patients with toxic nodular goitre and 87 patients with Graves' disease. Subtotal thyroidectomy in 25 patients with Graves' disease (early period of the study); lobectomy with resection of the isthmus of the thyroid in 62 patients with a solitary toxic adenoma.
MAIN OUTCOME MEASURES: Mortality, morbidity and patients' self assessment of the results of operation (symptoms, scar, ophthalmopathy).
RESULTS: There was no mortality. Morbidity included 2 postoperative bleeds that required reoperation; 2 patients developed permanent unilateral vocal cord paralysis and 2 had permanent hypoparathyroidism. In 27 of the 400 patients (7%) a thyroid carcinoma was found in the resected specimen. No patient had persistent or recurrent hyperthyroidism 2 to 10 years after operation. Of the 49 patients with Graves' disease and opthalmopathy at the time of operation, 35 (71%) reported improvement in their ophthalmopathy and 14 (29%) reported no improvement. No patient had worsening of their exophthalmos; 388 (97%) were satisfied with their incision; and 360 (90%) reported a significant improvement in their preoperative symptoms (tachycardia, weakness, anxiety, and pressure in the neck).
CONCLUSIONS: We suggest that the primary treatment of all types of hyperthyroidism should be surgical.