The surgical treatment for Graves' disease is generally subtotal thyroidectomy which consists of resecting most of the thyroid tissue leaving only a small remnant . The main issue of this operation is the particular criteria for the remnant
thyroid
weight which is reasonable to obtain the lowest recurrence and hypothyroidism rate. This study was carried out in 436 patients surgically treated for Graves' disease from Jan. 1984 through Oct. 1992 to evaluate th outcomes of surgical treatment
and
to
determine the possible prognostic factors affecting thyroid function after operation.
@ES The duration of follow-up varied from 3 to 10 years.
@EN 1) Among the 436 cases who underwent bilateral subtotal thyroidectomy, the number of patients who obtained remission to normal thyroid function were 338 cases(77.6%) and hypothyroidism in 49 cases(11.2%) while recurrence occurred in 49
cases(11.2%).
2) Of the 49 cases of hypothyroidism, 46 cases(93.6%) were seen within 2 years of the operation. and of the 40 recurred cases, 30 cases(61.2%) also occurred within 2 years. However, the recurrence can be seen even after 2 years.
3) The possible prognostic factors affecting the postoperative thyroid function, including those with age, sex, antithyroid antibody titer, antimicrosomal antibody titer, the resected thyroid weight, the remnant thyroid weight, the degree of
lymphocytic infiltration, and preoperative TBII, value were evaluated to predict the outcome after the operation and the result was that none of these fators except the thyroid remnant weight had any correlation with the postoperative thyroid
function.
4) The cases in whom there was an increase in the TBII value during follow-up period had a high recurrence rate.
Our result suggests that the bilateral subtotal thyroidectomy leaving around 6 gms of thyroid remnant remains a reasonable approach to the treatment of Graves' disease. However, there is no specific prognostic factor in determine the exact amount
of
thyroid remnant for the best postoperative results.
The postoperative increase in TBII values may be possible to predict the recurrence of hyperthyoidism.
|