Alsanea O, Clark O H
Department of Surgery, University of California San Francisco Medical Center, USA.
Endocrinol Metab Clin North Am. 2000 Jun;29(2):321-37. doi: 10.1016/s0889-8529(05)70134-1.
The authors and others believe that surgery (thyroidectomy) is underused in the treatment for patients with Graves' disease. It is the most rapid and consistent method of making the patient euthyroid; it avoids the possible long-term risks of radioactive iodine; and it provides tissue for histologic examination. Children, young women, pregnant women, and patients with coexistent thyroid nodules are ideal candidates for thyroidectomy. It also is the treatment of choice for patients with Graves' ophthalmopathy. Patients should be rendered euthyroid before thyroidectomy. Although the operation is technically more difficult than operating on patients with nontoxic goiter or thyroid neoplasms because of the vascularity of the thyroid gland, this difference is small, and the complication rates are low. The authors recommend the Hartley-Dunhill operation (total thyroidectomy on one side and subtotal thyroidectomy on the other side, leaving about 4 to 5 g of thyroid tissue) for most patients and total thyroidectomy for patients with Graves' ophthalmopathy. In patients with recurrent or persistent thyroid cancer who fail to respond to surgery and radioactive iodine ablation, immunosuppressive therapy should be considered.
作者及其他人士认为，手术（甲状腺切除术）在格雷夫斯病患者的治疗中未得到充分应用。它是使患者达到甲状腺功能正常的最迅速且稳定的方法；它避免了放射性碘可能带来的长期风险；并且它能提供组织用于组织学检查。儿童、年轻女性、孕妇以及合并甲状腺结节的患者是甲状腺切除术的理想候选者。它也是格雷夫斯眼病患者的首选治疗方法。在进行甲状腺切除术之前，应使患者的甲状腺功能恢复正常。尽管由于甲状腺的血管丰富，该手术在技术上比为非毒性甲状腺肿或甲状腺肿瘤患者进行手术更困难，但这种差异很小，且并发症发生率较低。作者建议大多数患者采用哈特利 - 邓希尔手术（一侧行全甲状腺切除术，另一侧行次全甲状腺切除术，保留约4至5克甲状腺组织），而格雷夫斯眼病患者则行全甲状腺切除术。对于复发性或持续性甲状腺癌患者，若对手术和放射性碘消融治疗无反应，则应考虑免疫抑制治疗。
