Graves 病行甲状腺全切除术：未必始终需要遵循美国甲状腺协会指南。
Total thyroidectomy for Graves' disease: compliance with American Thyroid Association guidelines may not always be necessary.
机构信息
Department of Surgery, Vanderbilt University Medical Center, Nashville, Nashville, TN.
出版信息
Surgery. 2013 Nov;154(5):1009-15. doi: 10.1016/j.surg.2013.04.064. Epub 2013 Sep 26.
BACKGROUND
Total thyroidectomy (TT) is the preferred operative approach to Graves' disease. Current guidelines of the American Thyroid Association call for the administration of potassium iodide (KI) and achievement of euthyroid state before operation. Small numbers and a mixture of operative approaches spanning several decades hinder previous operative series. We present the outcomes for TT at a single high-volume center.
METHODS
A retrospective cohort study was conducted on 165 patients undergoing TT for Graves' disease from July 2007 to May 2012.
RESULTS
Mean age was 43 years (range, 17-78), and 128 patients (78%) were female. A total of 95% of patients were on methimazole or propylthiouracil, and 42% remained hyperthyroid at time of TT. Only 3 (2%) patients received KI. Mean operative time was 132 minutes (range, 59-271). Mean gland size and blood loss were 41 g (range, 8-180) and 55 mL (range, 10-1050), respectively. No patient developed thyroid storm. Median follow-up was 7.5 months. Temporary and permanent hypocalcemia developed in 51 (31%) and 2 patients (1.2%), respectively. Temporary and permanent recurrent laryngeal nerve paresis occurred in 12 (7%) and one (0.6%) patient, respectively. Sixty-one (37%) patients experienced at least one complication. On multivariate analysis, patient age younger than 45 years (odds ratio 2.93, 95% confidence interval 1.39-6.19) and obesity (odds ratio 2.11, 95% confidence interval 1.00-4.43) were associated with the occurrence of complications.
CONCLUSION
This high-volume surgeon experience demonstrates no appreciable detriment to patient outcomes when recommendations of the American Thyroid Association for routine use of KI and euthyroid state before thyroidectomy are not met. Transient hypocalcemia and hoarseness are frequent complications of TT for Graves' disease, resolving within 6 months in most patients. Age younger than 45 years and obesity are risk factors for postoperative complications.
背景
甲状腺全切除术（TT）是治疗格雷夫斯病的首选手术方法。美国甲状腺协会的现行指南要求在手术前给予碘化钾（KI）并达到甲状腺功能正常状态。由于数量较少且手术方法跨越了几十年，因此之前的手术系列受到了阻碍。我们在一家高容量中心展示了 TT 的结果。
方法
对 2007 年 7 月至 2012 年 5 月期间因格雷夫斯病接受 TT 的 165 例患者进行了回顾性队列研究。
结果
平均年龄为 43 岁（范围，17-78 岁），128 例（78%）为女性。95%的患者服用甲巯咪唑或丙基硫氧嘧啶，42%的患者在 TT 时仍处于甲状腺功能亢进状态。只有 3 例（2%）患者接受了 KI。平均手术时间为 132 分钟（范围，59-271）。平均腺体大小和出血量分别为 41g（范围，8-180）和 55mL（范围，10-1050）。没有患者发生甲状腺危象。中位随访时间为 7.5 个月。51 例（31%）和 2 例（1.2%）患者分别出现暂时性和永久性低钙血症。12 例（7%）和 1 例（0.6%）患者出现暂时性和永久性喉返神经麻痹。61 例（37%）患者至少发生了一次并发症。多变量分析显示，年龄小于 45 岁（优势比 2.93，95%置信区间 1.39-6.19）和肥胖（优势比 2.11，95%置信区间 1.00-4.43）与并发症的发生相关。
结论
当美国甲状腺协会关于甲状腺切除术前常规使用 KI 和甲状腺功能正常状态的建议未得到满足时，这位高容量外科医生的经验并未显示对患者预后有明显影响。暂时性低钙血症和声音嘶哑是格雷夫斯病 TT 的常见并发症，大多数患者在 6 个月内可自行缓解。年龄小于 45 岁和肥胖是术后并发症的危险因素。
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