Endocrine Abstracts

Graves’ disease is a common autoimmune condition, and the most common cause of hyperthyroidism. A number of definitive treatment options for this disease exist, including radioiodine (RI) and surgery. Surgery is often reserved for patients for whom RI is contraindicated or who have previously failed other treatments, including radioactive iodine ablation (RIA). The aim of this study was to assess the efficacy and safety of total thyroidectomy at our institution as a preferred primary treatment option for patients with Grave’s Disease. A total of 98 consecutive cases of total thyroidectomy for the primary treatment of Grave’s Disease were analyzed. Patients assessed in our retrospective study had a very low rate of complications and there was no mortality. There were no cases of voice disturbance associated with recurrent laryngeal nerve injury. The rate of hypocalcemia (transient 11.3%; persistent beyond 6 months 1%) was low and there was only one return to the operating room for evacuation of hematoma. The only patient with more persistent hypoparathyroidism recovered her parathyroid hormone levels at 18 months. Patients’ symptoms, including symptoms related to hyperthyroidism, pressure related symptoms and ophthalmopathy, significantly improved in the follow up period. 17.2% of patients in this study had papillary cancer incidentally present in the surgical specimen on pathology. This study provides evidence that in selected patients with Graves’ disease, surgical management with total thyroidectomy should be considered a safe and effective first line treatment. It provides complete and safe cure of disease and rapid resolution of symptoms. In addition, in our study, the simultaneous excision of incidental papillary cancer was a significant added benefit of total thyroidectomy.