Hermann M, Roka R, Richter B, Koriska K, Göbl S, Freissmuth M
Department of Surgery, Kaiserin-Elisabeth-Spital, Vienna, Austria.
Surgery. 1999 May;125(5):522-8.
In Graves' disease radioiodine is the recommended treatment for relapses after subtotal thyroidectomy. If patients reject radioiodine, hyperthyroidism is managed with antithyroid drugs; surgery is generally not considered as an alternative. Here we retrospectively analyzed 30 consecutive patients with Graves' disease who had recurrent hyperthyroidism after subtotal thyroidectomy.
On relapse after the first operation, the patients were initially treated by medication; 25 opted for definitive treatment (19 for reoperation and 6 for radioiodine). Operations consisted of 10 unilateral and 8 bilateral resections (total or near-total with capsular remnants of < 1 g) and 1 transsternal approach (because of dystopic intrathoracic thyroid tissue). The decision between a unilateral and a bilateral reintervention was based on the ultrasonographic determination of remnant volumes. These size estimates were valid because they were significantly correlated to the weight of the resected remnants (r = 0.92, slope = 0.95). Eighteen of the 19 patients were adequately treated by this approach. Unilateral resection was performed in 1 patient with a remaining contralateral remnant of 5.4 mL; this patient had a second relapse. The complication rate was low (2 cases of transient recurrent nerve injury and 1 of transient hypocalcemia).
Provided that no contraindication is present, reoperation is safe, effective, and expeditious in recurrent hyperthyroidism. Because the likelihood of a recurrence depends on the total remnant size, the goal is to keep it below 2 g. Preoperative ultrasonography can effectively guide the decision between a unilateral and a bilateral resection.
在格雷夫斯病中，放射性碘是甲状腺次全切除术后复发的推荐治疗方法。如果患者拒绝放射性碘治疗，甲亢则采用抗甲状腺药物治疗；手术通常不作为替代方案。在此，我们回顾性分析了30例连续的甲状腺次全切除术后复发性甲亢的格雷夫斯病患者。
首次手术后复发时，患者最初采用药物治疗；25例选择了确定性治疗（19例再次手术，6例放射性碘治疗）。手术包括10例单侧切除和8例双侧切除（全切除或近全切除，保留的包膜残余组织<1 g）以及1例经胸骨入路手术（因异位胸内甲状腺组织）。单侧和双侧再次手术的决策基于超声测定残余甲状腺组织的体积。这些体积估计是有效的，因为它们与切除的残余组织重量显著相关（r = 0.92，斜率 = 0.95）。19例患者中有18例通过这种方法得到了充分治疗。1例患者对侧残余甲状腺组织为5.4 mL，进行了单侧切除；该患者再次复发。并发症发生率较低（2例短暂性喉返神经损伤和1例短暂性低钙血症）。
在不存在禁忌证的情况下，再次手术治疗复发性甲亢安全、有效且迅速。由于复发的可能性取决于残余甲状腺组织的总体积，目标是将其保持在2 g以下。术前超声检查可有效指导单侧和双侧切除的决策。
