Modified subtotal thyroidectomy in the management of Graves' disease.

A prospective study of a new surgical approach (modified subtotal thyroidectomy) in the management of Graves' disease was carried out in 55 patients. The patients were followed over an average of 4 years with a strict protocol involving serial clinical and chemical evaluations (T4, T3RIA, TSH) and yearly thyroid scans. Long-term euthyroidism was achieved in 94% of the patients. These results are markedly superior to the functional results occurring after the standard thyroidectomy in widespread current use. In particular, the development of postoperative hypothyroidism, which is usually manifest by the second year after operation, has not occurred in this series. Observations of TSH elevations in som euthyroid postoperative patients may have important implications regarding the mechanism by which appropriate surgical resection favorably affects the pathophysiology of Graves' disease.