Sun Hanxing, Tong Hui, Shen Xiaohui, Gao Haoji, Kuang Jie, Chen Xi, Li Qinyu, Qiu Weihua, Liu Zhuoran, Yan Jiqi
Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China.
J Clin Med. 2023 Feb 7;12(4):1308. doi: 10.3390/jcm12041308.
The role of surgery in the treatment of Graves' disease (GD) needs to be revisited. The aims of the present retrospective study were to evaluate the outcomes of the current surgical strategy as a definitive treatment of GD at our center and to explore the clinical association between GD and thyroid cancer.
A patient cohort of 216 cases from 2013 to 2020 was involved in this retrospective study. The data of the clinical characteristics and follow-up results were collected and analyzed.
There were 182 female and 34 male patients. The mean age was 43.9 ± 15.0 years old. The mean duration of GD reached 72.2 ± 92.7 months. Of the 216 cases, 211 had been treated with antithyroid drugs (ATDs) and hyperthyroidism had been completely controlled in 198 cases. A total (75%) or near-total (23.6%) thyroidectomy was performed. Intraoperative neural monitoring (IONM) was applied to 37 patients. The failure of ATD therapy (52.3%) was the most common surgical indication, followed by suspicion of a malignant nodule (45.8%). A total of 24 (11.1%) patients had hoarseness after the operation and 15 (6.9%) patients had transient vocal cord paralysis; 3 (1.4%) had this problem permanently. No bilateral RLN paralysis occurred. A total of 45 patients had hypoparathyroidism and 42 of them recovered within 6 months. Sex showed a correlation with hypoparathyroidism through a univariate analysis. A total of 2 (0.9%) patients underwent a reoperation because of hematomas. A total of 104 (48.1%) cases were diagnosed as thyroid cancer. In most cases (72.1%), the malignant nodules were microcarcinomas. A total of 38 patients had a central compartment node metastasis. A lateral lymph node metastasis occurred in 10 patients. Thyroid carcinomas were incidentally discovered in the specimens of 7 cases. The patients with concomitant thyroid cancer had a significant difference in body mass index, duration of GD, gland size, thyrotropin receptor antibodies and nodule(s) detected.
Surgical treatments for GD were effective, with a relatively low incidence of complications at this high-volume center. Concomitant thyroid cancer is one of the most important surgical indications for GD patients. Careful ultrasonic screening is necessary to exclude the presence of malignancies and to determine the therapeutic plan.
需要重新审视手术在格雷夫斯病（GD）治疗中的作用。本回顾性研究的目的是评估当前手术策略作为我院GD确定性治疗方法的效果，并探讨GD与甲状腺癌之间的临床关联。
本回顾性研究纳入了2013年至2020年的216例患者队列。收集并分析了临床特征和随访结果的数据。
女性患者182例，男性患者34例。平均年龄为43.9±15.0岁。GD的平均病程达72.2±92.7个月。216例患者中，211例曾接受抗甲状腺药物（ATD）治疗，198例患者的甲亢得到完全控制。共进行了全甲状腺切除术（75%）或近全甲状腺切除术（23.6%）。37例患者术中应用了神经监测（IONM）。ATD治疗失败（52.3%）是最常见的手术指征，其次是怀疑恶性结节（45.8%）。共有24例（11.1%）患者术后出现声音嘶哑，15例（6.9%）患者出现短暂性声带麻痹；3例（1.4%）患者永久性出现该问题。未发生双侧喉返神经麻痹。共有45例患者发生甲状旁腺功能减退，其中42例在6个月内恢复。单因素分析显示性别与甲状旁腺功能减退相关。共有2例（0.9%）患者因血肿接受了再次手术。共有104例（48.1%）病例被诊断为甲状腺癌。在大多数病例（72.1%）中，恶性结节为微小癌。共有38例患者发生中央区淋巴结转移。10例患者发生侧方淋巴结转移。7例患者的标本中偶然发现甲状腺癌。合并甲状腺癌的患者在体重指数、GD病程、腺体大小、促甲状腺素受体抗体及检测到的结节方面存在显著差异。
在这个大型中心，GD的手术治疗是有效的，并发症发生率相对较低。合并甲状腺癌是GD患者最重要的手术指征之一。需要仔细进行超声筛查以排除恶性肿瘤的存在并确定治疗方案。
