Cipolla Calogero, Graceffa Giuseppa, Calamia Sergio, Fiorentino Eugenio, Pantuso Gianni, Vieni Salvatore, Latteri Mario
University of Palermo, Department of Surgical Oncological and Oral Sciences, Division of General and Oncological Surgery, Palermo, Italy.
J Clin Transl Endocrinol. 2019 Feb 7;16:100183. doi: 10.1016/j.jcte.2019.100183. eCollection 2019 Jun.
Thyroidectomy is the preferred approach as the definitive treatment for Graves' disease. The outcomes for total thyroidectomy in a large series of 594 patients, who were observed in the last decade, will be presented in this study.
The study concerned a retrospective review of 594 patients, undergoing a total thyroidectomy for Graves' disease. The incidence of complications and outcomes on hyperthyroidism and correlated symptoms resolution were also evaluated.
The mean age of the patients was of 44.7 ± 12.7 years and 456 patients (76.7%) were females. The mean gland weight was 67.3 ± 10.8 g (range: 20-350 g) and, in 397 patients (66.8%), the gland weighed >40 g. The mean operative time was 125 ± 23.1 min (range: 65-212 min). Temporary and permanent hypocalcaemia developed in 241 (40.6%) and 3 patients (0.5%), respectively. Temporary and permanent recurrent laryngeal nerve palsy were recorded in 31 (5.2%) and 1 patients (0.16%) respectively. No patient developed a thyroid storm. On multivariate analysis, patient age ≤50 years (Odds ratio: 1; 95% Confidence Interval: 0.843-0.901) and thyroid weight >40 g (Odds ratio: 1; 95%, Confidence Interval: 0.852-0.974), were mainly associated with the occurrence of complications.
This high-volume surgeon experience demonstrates that total thyroidectomy is a safe and effective treatment for Graves' disease. It is associated with a very low incidence rate of post-operative complications, most of which are transitory; therefore, it offers a rapid and definitive control of hyperthyroidism and its related symptoms.
甲状腺切除术是格雷夫斯病确定性治疗的首选方法。本研究将呈现过去十年中对594例患者进行全甲状腺切除术的结果。
本研究对594例行格雷夫斯病全甲状腺切除术的患者进行回顾性分析。还评估了并发症的发生率以及甲亢和相关症状缓解的结果。
患者的平均年龄为44.7±12.7岁，456例患者（76.7%）为女性。平均腺体重量为67.3±10.8g（范围：20 - 350g），397例患者（66.8%）的腺体重量>40g。平均手术时间为125±23.1分钟（范围：65 - 212分钟）。分别有241例（40.6%）和3例（0.5%）发生了暂时性和永久性低钙血症。分别有31例（5.2%）和1例（0.16%）记录到暂时性和永久性喉返神经麻痹。无患者发生甲状腺危象。多因素分析显示，患者年龄≤50岁（比值比：1；95%置信区间：0.843 - 0.901）和甲状腺重量>40g（比值比：1；95%置信区间：0.852 - 0.974）主要与并发症的发生相关。
这位经验丰富的外科医生的经验表明，全甲状腺切除术是格雷夫斯病的一种安全有效的治疗方法。它与术后并发症的发生率非常低相关，其中大多数是暂时性的；因此，它能快速且确定性地控制甲亢及其相关症状。
