Lepner Urmas, Seire Indrek, Palmiste Veronika, Kirsimägi Ulle
Department of Surgery, University of Tartu, Tartu, Estonia.
Medicina (Kaunas). 2008;44(1):22-6.
The aim of this prospective study was to report our results after thyroidectomy for Graves' disease. In addition, the relationship between the thyroid remnant and postoperative thyroid function was studied.
Forty-nine consecutive patients were operated on for Graves' disease. The indications for surgery were persistent or recurrent hyperthyroidism after medical treatment in 34 patients (69.4%), mechanical symptoms due to a large goiter in 7 (14.3%), increased ophthalmopathy in 7 (14.3%), and allergy to antithyroid medications in 1 patient (2.0%). Total thyroidectomy (TT) was performed in 28 and subtotal thyroidectomy (STT) in 21 patients. Follow-up lasted 24 to 70 months.
There was no statistically significant difference in the rate of postoperative complications comparing TT and STT. The patients who underwent TT had no recurrence during a mean follow-up of 47 months. After STT, with the mean weight of the thyroid remnant 3.0+/-1.0 g, there was no relapse of Graves' disease during a mean follow-up of 52 months. After STT, postoperative hypothyroidism developed in 14 patients (66.7%); 7 patients (33.3%) remained euthyroid during follow-up. Comparison of the euthyroid patients and the hypothyroid patients revealed no difference in the weight of the remnant (3.3 g vs. 2.8 g), but a statistically significant difference occurred in the weight of the resected gland (61.0 g vs. 94.4 g, P=0.026) and in the proportion of the remnant (5.6% vs. 3.3%, P=0.030).
Both TT and STT are safe procedures regarding postoperative complication rate. STT with the thyroid remnant of about 3 g allows to permanently cure hyperthyroidism ensuring the euthyroid state in a significant proportion of patients. Postoperative thyroid function after STT is best predicted by the proportion of the remnant.
本前瞻性研究旨在报告我们对格雷夫斯病患者行甲状腺切除术后的结果。此外，还研究了甲状腺残余组织与术后甲状腺功能之间的关系。
连续49例格雷夫斯病患者接受了手术治疗。手术指征包括：34例（69.4%）药物治疗后持续性或复发性甲亢；7例（14.3%）因巨大甲状腺肿出现机械性症状；7例（14.3%）突眼症状加重；1例（2.0%）对抗甲状腺药物过敏。28例行全甲状腺切除术（TT），21例行次全甲状腺切除术（STT）。随访时间为24至70个月。
比较TT和STT，术后并发症发生率无统计学显著差异。接受TT的患者在平均47个月的随访期间无复发。STT后，甲状腺残余组织平均重量为3.0±1.0 g，在平均52个月的随访期间格雷夫斯病无复发。STT后，14例患者（66.7%）发生术后甲状腺功能减退；7例患者（33.3%）在随访期间保持甲状腺功能正常。甲状腺功能正常患者与甲状腺功能减退患者相比，残余组织重量无差异（3.3 g对2.8 g），但切除腺体的重量有统计学显著差异（61.0 g对94.4 g，P = 0.026），残余组织比例也有统计学显著差异（5.6%对3.3%，P = 0.030）。
就术后并发症发生率而言，TT和STT都是安全的手术方式。甲状腺残余组织约3 g的STT能够永久性治愈甲亢，确保相当比例的患者处于甲状腺功能正常状态。STT术后的甲状腺功能最好通过残余组织的比例来预测。
