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Bretterklieber, C.
Surgical Therapy of Graves'Disease - A Comparison of Two Methods
[ Dissertation ] Medical University of Graz; 2004. pp.

Authors Med Uni Graz:
Advisor:: Leb Georg; Wolf Gerhard
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Abstract:: Autoimmune hyperthyroidism (Graves disease) can be treated with thyrostatic drugs, radioiodine, or surgery. Rapid endocrinologic and immunologic remission, low complication rate, predictable outcome and low risk of recurrence when thyroid remnant is smaller than 3-4 ml, positive effect on associated ophthalmopathy, and curative treatment of coexisting (papillary) thyroid carcinoma are characteristics of surgical treatment. In this study, 40 patients, who were operated for Graves disease at the department of Surgery at the university Hospital in Graz between 2000 and 2002, were analyzed retrospectively in order to compare conventional resection (n0239 and en bloc resection (n=179 with respect to the complication rate. Between 4 and 42 months postoperatively, 13 patients of 22 were euthyroid, 3 latent hyperthyroid, 4 latent hypothyroid and 2 were hypothyroid. No significance was found when comparing the frequency of complications between the 2 groups: 1 patient in each group had permanent hypoparahtyoidism (> 9 months postoperatively), 8 vs. 5 patients after en bloc and conventional thyroidectomy had transient hypocalcemia. Injury of the recurrent laryngeal nerve was not permanent in any case. Dysphonia was recognized in 5 patients after en bloc and in 8 after conventional resection, lasting for 1 week up to less than 9 months. In 1 patient after conventional thyroidectomy, surgical revision because of hematoma was performed. Avoidance of major bleeding, reduced release of thyroid hormones and antigens (and possibly carcinoma cells) because of less thyroid tissue damage and easier estimation of the remnant size are the advantages of the en bloc resection. It is therefore a preferable alternative as surgical treatment in Graves disease.