Lin Yann-Sheng, Lin Jen-Der, Hsu Chih-Chieh, Yu Ming-Chin
Department of Surgery, Chang Gung Memorial Hospital Linkou Branch, Chang Gung University, Taoyuan City, Taiwan (R.O.C.).
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital Linkou Branch, Chang Gung University, Taoyuan City, Taiwan (R.O.C.).
J Surg Res. 2017 Dec;220:112-118. doi: 10.1016/j.jss.2017.06.091. Epub 2017 Jul 26.
Surgical management of Graves' disease (GD) is changing from subtotal to total thyroidectomy because the latter eliminates the risk of recurrence. However, to preserve thyroid function in a euthyroid state, subtotal thyroidectomy is still performed for GD in non-Western countries. Therefore, we designed a study to investigate the long-term outcomes in GD patients after subtotal thyroidectomy and the correlation between remnant weight and postoperative thyroid function.
This was a retrospective cohort observation study. Between January 2005 and December 2011, 415 consecutive GD patients treated by subtotal thyroidectomy were enrolled. All data were collected from 385 patients who underwent bilateral subtotal thyroidectomy and 57 patients who underwent the Hartley-Dunhill operation. The median postoperative follow-up time was 72 months (range 12-144 months).
The mean weight of the preserved thyroid remnant was 5.1 g. Persistent or recurrent hyperthyroidism was observed in 119 (28.7%) patients. The median time of recurrence was 36 months (range 12-120 months). Hypothyroidism developed in over 50% of patients. A euthyroid state was achieved in only 19.3% of patients, and the rate did not increase significantly as remnant weight increased. Based on a Cox regression analysis, the remnant weight is an independent risk factor for persistent or recurrent hyperthyroidism (hazard ratio: 1.323, 95% confidence interval: 1.198-1.461, P < 0.001).
Subtotal thyroidectomy with the intent to maintain a euthyroid state is not an optimal surgical strategy for the definitive treatment of GD because the persistence or recurrence rate is high and the euthyroid rate is lower than expected.
格雷夫斯病（GD）的手术治疗正从甲状腺次全切除术转变为甲状腺全切除术，因为后者可消除复发风险。然而，为了在甲状腺功能正常状态下保留甲状腺功能，非西方国家仍对GD患者施行甲状腺次全切除术。因此，我们设计了一项研究，以调查甲状腺次全切除术后GD患者的长期结局以及残余甲状腺重量与术后甲状腺功能之间的相关性。
这是一项回顾性队列观察研究。2005年1月至2011年12月期间，连续纳入415例行甲状腺次全切除术治疗的GD患者。所有数据均来自385例行双侧甲状腺次全切除术的患者和57例行哈特利-邓希尔手术的患者。术后中位随访时间为72个月（范围12 - 144个月）。
保留的甲状腺残余组织平均重量为5.1克。119例（28.7%）患者出现持续性或复发性甲亢。复发的中位时间为36个月（范围12 - 120个月）。超过50%的患者发生了甲状腺功能减退。仅19.3%的患者实现了甲状腺功能正常状态，且该比例并未随着残余甲状腺重量的增加而显著升高。基于Cox回归分析，残余甲状腺重量是持续性或复发性甲亢的独立危险因素（风险比：1.323，95%置信区间：1.198 - 1.461，P < 0.001）。
旨在维持甲状腺功能正常状态的甲状腺次全切除术并非GD确定性治疗的最佳手术策略，因为其持续性或复发率较高且甲状腺功能正常率低于预期。
