Catania A, Guaitoli E, Carbotta G, Bianchini M, Di Matteo F M, Carbotta S, Nardi M, Fabiani E, Grani G, D'Andrea V, Fumarola A
Departments of Surgical Sciences, and Experimental Medicine, Endocrinology Unit A, Sapienza University, Rome, Italy.
Clin Ter. 2013 May-Jun;164(3):193-6. doi: 10.7417/CT.2013.1548.
Graves' disease (GD) is the most common cause of hyperthyroidism, and accounts worldwide for 60-80% of all cases. The diagnosis is based on clinical findings, and is confirmed by the presence of TRAB, suppression of TSH, and elevation of free thyroxin (free T4), and triiodinethyronin (free T3). GD can be treated by antithyroid drugs, radioactive iodine, or surgery. The aim of this study was to review retrospectively the surgical management, in terms of safety and efficacy, in 50 patients operated in the Department of Surgical Sciences since 2005 through 2010 and followed up at the Endocrinology Unit A of the Experimental Medicine Department. We assessed postoperative complications, which included the presence, persistence and development of ophthalmopathy, transient hypocalcemia, permanent hypoparathyroidism and recurrent laryngeal nerve palsy.
We analyzed data from 50 patients with GD who were eligible and underwent Total Thyroidectomy (TT). Thirty-nine patients underwent TT for recurrent hyperthyroidism after medical therapy and eleven patients for severe ophtalmopathy. The mean follow up was 41 months (range: 10-70).
Eleven patients had ophtalmopathy before surgery. Four patients developed an ophtalmopathy after surgery. Eleven patients presented hypocalcemia, transient in ten patients and permanent in one patient. Five patients developed a transient disphony. Conclusions. Total thyroidectomy is a safe and radical procedure in Graves' disease treatment. Complications of TT are not different than subtotal thyroidectomy if it's performed by expert surgeons.
格雷夫斯病（GD）是甲状腺功能亢进最常见的病因，在全球所有病例中占60 - 80%。诊断基于临床表现，并通过促甲状腺素受体抗体（TRAB）的存在、促甲状腺激素（TSH）的抑制以及游离甲状腺素（游离T4）和三碘甲状腺原氨酸（游离T3）的升高得以确诊。GD可通过抗甲状腺药物、放射性碘或手术进行治疗。本研究的目的是回顾性分析自2005年至2010年在外科科学部接受手术并在实验医学部内分泌科A组进行随访的50例患者的手术治疗在安全性和有效性方面的情况。我们评估了术后并发症，包括眼病的出现、持续和发展、短暂性低钙血症、永久性甲状旁腺功能减退和喉返神经麻痹。
我们分析了50例符合条件并接受全甲状腺切除术（TT）的GD患者的数据。39例患者因药物治疗后甲亢复发接受TT，11例患者因严重眼病接受TT。平均随访时间为41个月（范围：10 - 70个月）。
11例患者术前有眼病。4例患者术后出现眼病。11例患者出现低钙血症，10例为短暂性，1例为永久性。5例患者出现短暂性声音嘶哑。结论。全甲状腺切除术在格雷夫斯病治疗中是一种安全且彻底的手术。如果由专业外科医生进行，TT的并发症与次全甲状腺切除术并无差异。
