Nicolosi A, Meleddu C, Meleddu G, Massidda B, Calò P G, Pinna M, Tarquini A
Istituto di Chirurgia e Oncologia, Università degli Studi, Cagliari.
Minerva Chir. 1995 Jul-Aug;50(7-8):659-65.
Between 1973 and 1992 153 patients with Graves' disease were observed at the Surgery and Oncology Institute-Cagliari University. 103 underwent subtotal (70) or total (33) thyroidectomy, while 50(after 1985) were submitted to radioactive-iodine therapy. Surgical indications were failure of antithyroid drug therapy, signs of compression and large size goitre. Until 1988, all patients were submitted to subtotal thyroidectomy with thyroid remnant of about 8 g. From 1988 the choice of total thyroidectomy came out from: similar complications (paralysis of recurrent nerve and hypoparathyroidism), lack of relapse and suppression of risk of occult carcinoma. After subtotal thyroidectomy definitive hypoparathyroidism in 1 patient (1.8%), transitory hypoparathyroidism in 5 (9.4%), clinical hypothyroidism in 17 (31.5%), recidive hyperthyroidism in 3 patients (5.5%) were observed. After total thyroidectomy 1 patient presented definitive paralysis of recurrent nerve (3%), 1 definitive hypoparathyroidism (3%), 8 transitory hypoparathyroidism (24%): small (44 patients) or large goitre (3 patients) or relapse (3 patients) were indications to radioactive-iodine therapy. At median follow-up of 16 months no relapses of hyperthyroidism were observed, while clinical signs of hypothyroidism were present in 33% of patients. Authors stress that, after a first attempt with antithyroid drugs therapy, radioiodine treatment is elective in Graves' disease. Surgery still remains the treatment of choice during pregnancy, in patients with large goitres, signs of compression or in presence of scintigraphic "cold" area.
1973年至1992年间，卡利亚里大学外科与肿瘤研究所对153例格雷夫斯病患者进行了观察。103例行次全（70例）或全（33例）甲状腺切除术，而50例（1985年后）接受放射性碘治疗。手术指征为抗甲状腺药物治疗失败、压迫症状和巨大甲状腺肿。直到1988年，所有患者均行次全甲状腺切除术，保留约8g甲状腺残余组织。从1988年起，选择全甲状腺切除术的原因如下：并发症相似（喉返神经麻痹和甲状旁腺功能减退）、无复发以及隐匿性癌风险降低。次全甲状腺切除术后，观察到1例患者出现永久性甲状旁腺功能减退（1.8%），5例出现暂时性甲状旁腺功能减退（9.4%），17例出现临床甲状腺功能减退（31.5%），3例患者复发甲亢（5.5%）。全甲状腺切除术后，1例患者出现永久性喉返神经麻痹（3%），1例出现永久性甲状旁腺功能减退（3%），8例出现暂时性甲状旁腺功能减退（24%）：甲状腺较小（44例）或较大（3例）或复发（3例）是放射性碘治疗的指征。中位随访16个月时，未观察到甲亢复发，而33%的患者出现甲状腺功能减退的临床症状。作者强调，在首次尝试抗甲状腺药物治疗后，放射性碘治疗是格雷夫斯病的选择性治疗方法。手术仍是孕期、甲状腺巨大、有压迫症状或存在闪烁扫描“冷”区患者的首选治疗方法。
