Grave’s Disease: A systematic review of surgical indications, management and complications in a cohort of 59 patients.

Stathopoulos Panagiotis, Kotrotsos George, Hickey Simon, Cunliffe David.

Torbay General Hospital, UK

A retrospective analysis of 59 patients who underwent total thyroidectomy for the treatment of   Grave’s disease over a 6-year period was conducted with purpose to assess the current indications and to identify any specific factors that may influence patients’ decision to opt for surgical treatment. A comparison of outcomes between the current study and a similar one from an Endocrine Surgical Unit in Hong Kong is attempted to evaluate factors that may be associated with surgical complications.

Patient preference was the most common reason for opting for surgery over radioactive iodine in both studies (31.9% and 37.2%). Other indications for surgery such as Graves’ orbitopathy (30.1% vs 28.8%), patient’s refusal for radioactive iodine (10.2% vs 15.2%), large goitre with pressure symptoms (6% vs 5%), planning for pregnancy (6% vs 8.4%) , young age (3% vs 1.6%) and intolerance to antithyroid drugs (4.8% vs 3.3%), were also similar in the two groups. There were no statistically significant differences in temporary and permanent recurrent laryngeal nerve palsy between the two groups of patients. The rates of permanent hypoparathyroidism in Hong Kong and Devon patients were 5.4% and 5% respectively. Both studies revealed that there were no patients with recurrent Grave’s disease after total thyroidectomy however all of them required daily thyroxine replacement.

Our findings confirmed that patient preference is the leading indication for surgery, implicating a continuous misconception of radioactive substances and increasing confidence in surgical outcomes. In experienced hands the risk of recurrent laryngeal nerve injury and permanent hypoparathyroidism remains minimal.