Endocrine Abstracts

Background: Surgery which was until sixty years ago the only treatment available for Graves’ disease (Gd) is now the last recommended therapeutical option, the number of thyroidectomies (Tx) being in continous decrease. American physicians prefere radioiodine use while their European and Japanese colleagues like better long-term administration of antithyroid drugs.

Patients and methods: A retrospective study carried out on 52 consecutive patients with Gd [female/male rate of 46/6 and age range at 28–65 (mean 44 years), representing 38.7% from all cases of thyrotoxicosis surgically treated in our clinic in the last two decennies, the annual number of such interventions is gradually diminished each year from 8 to only one. In all the cases a large subtotal Tx was performed (Dunhill’s technique in three patients) conserving less of 5 g of functional tissue. The weight of resected gland varied between 40 to 260 (range 80) g. We had not neither postoperative crisis nor mortality, but permanent recurrent palsy and hypoparathyroidism was noted each in only one case. None of operated patients developed hypothyroidism or recurrent thyrotoxicosis and exophtalmy – present in half of our cases – diminished in 5 patients and was stablished in the rest of them.

Discussion: The better understanding of biologic behavior and natural history of Gd and the availability of effectiveness of another modalities of treatment refined our own philosophy about indications for surgery. So we operated on only patients with failure, major adverse reaction or poor compliance at medical therapy and consumpting clinical syndrome, large size (third or fourth degree) of diffuse goiter eventually with presence of a dominant cold nodule with suspicious FNAB or refusal of radioiodine administration.

Conclusion: In the absence of the golden standard therapy of Gd and in spite of increased worldwide preference for medical and radioiodine treatment with correspondent reduction of number of thyroidectomies, surgery attentive indicated in selected cases proved yet to be a safe and highly efficient solution which quickly restores euthyroidism with minimal risk of anatomic and functional complications.