Department of General Surgery, Aberdeen Royal Infirmary, Aberdeen, UK.
J Otolaryngol Head Neck Surg. 2013 May 29;42(1):37. doi: 10.1186/1916-0216-42-37.
Surgery for Graves' disease may be performed with the intent of preserving thyroid function (subtotal thyroidectomy) or ablating thyroid function (total thyroidectomy). This study examines the evolving practice in a specialist endocrine surgical unit.
Longitudinal cohort study of patients undergoing surgery for Graves' disease between 1986 and 2008. Outcome measures were thyroid failure, recurrent toxicity, recurrent laryngeal nerve (RLN) palsy, early reoperation and hypocalcaemia. Time to thyroid failure was analysed by potential predictors.
Of 149 patients (129 female), 78 (52.3 percent) underwent subtotal thyroidectomy with the intention to preserve function (PF) and 71 (47.6 percent) total thyroidectomy with the intention to ablate thyroid function (AF). Mean duration of follow-up was 11.1 years; 14.8 years and 7.0 years respectively. Of 78 PF procedures: six (7.7 percent) patients suffered recurrent toxicity; 68 (87.2 percent) developed thyroid failure (four after treatment for recurrent toxicity); and eight (10 percent) remained euthyroid without replacement. Male gender and remnant gland weight were significant predictors of failure (P = 0.021 and 0.022 respectively). One patient developed permanent RLN palsy and one permanent hypocalcaemia. Of 71 AF procedures: one developed acute airway obstruction; one permanent RLN palsy; four permanent hypocalcaemia; and none developed recurrent toxicity. There were no deaths within a year of surgery. There was no statistically significant difference in complication rates.
Most PF resections resulted in eventual thyroid failure. The shift to ablative surgery virtually eliminated the need for lifelong specialist follow-up, albeit with an insignificant rise in permanent hypocalcaemia.
治疗格雷夫斯病（Graves’ disease）的手术可以保留甲状腺功能（甲状腺次全切除术）或消除甲状腺功能（甲状腺全切除术）。本研究检查了一个专科内分泌外科单位的手术实践演变。
对 1986 年至 2008 年间因格雷夫斯病而行手术的患者进行了纵向队列研究。结果测量指标包括甲状腺功能衰竭、毒性复发、喉返神经（recurrent laryngeal nerve，RLN）麻痹、早期再次手术和低钙血症。通过潜在预测因素分析甲状腺功能衰竭的时间。
149 例患者（129 例女性）中，78 例行甲状腺次全切除术，保留甲状腺功能（preserve function，PF），71 例行甲状腺全切除术，消除甲状腺功能（ablative function，AF）。中位随访时间分别为 11.1 年、14.8 年和 7.0 年。在 78 例 PF 手术中：6 例（7.7%）患者发生毒性复发；68 例（87.2%）发生甲状腺功能衰竭（4 例在治疗毒性复发后）；8 例（10%）患者无甲状腺功能减退而无需替代治疗。男性和残留腺体重量是功能衰竭的显著预测因素（P = 0.021 和 0.022）。1 例患者发生永久性 RLN 麻痹，1 例发生永久性低钙血症。在 71 例 AF 手术中：1 例发生急性气道梗阻；1 例永久性 RLN 麻痹；4 例永久性低钙血症；无一例发生毒性复发。术后一年内无死亡。并发症发生率无统计学差异。
大多数 PF 切除术后最终发生甲状腺功能衰竭。向消融手术的转变几乎消除了对终身专科随访的需求，尽管永久性低钙血症的发生率略有上升。
