Endocrine Abstracts

Background: Graves’ disease (GD) is a predominantly female autoimmune disorder of the thyroid gland. It is characterized by a diffuse goiter and biological hyperthyroidism. The optimal treatment of GD is still controversial. Surgery is one treatment option along with radioactive iodine (RAI) and antithyroid medication (ATM). The aim of the study is to review our experience in the surgical management in Graves’ disease.

Patients and Methods: This is a retrospective study involving patients who underwent surgery for Graves’ disease over a twelve-year period from January 2010 to December 2021.

Results: Our series included 51 patients, 38 women (75%) and 13 men (25%) with an average age of 39.41 years and extremes of 14 to 69 years. The mean time between diagnosis and surgical treatment was 18.4 months. At the time of diagnosis, cervical examination revealed a diffuse and homogeneous goiter in 22 cases (43%), nodular goiter in 6 cases (12%) and multi-nodular goiter in 23 patients (45%). Hyperthyroidism was observed in 23 patients (45.1%), and euthyroidism was noted in 28 patients (54.9%). In our series, surgery was indicated in cases of: resistance to medical treatment with an average duration of treatment with ATM of 12 months (84%), poor compliance (8%), associated thyroid carcinoma (6%) and treatment intolerance (2%). All our patients underwent total thyroidectomy with extemporaneous exam in 32 patients (62.7). Intraoperative examination suggested malignancy in 9 cases (17.6%). So, a bilateral central neck dissection was performed in these cases. Postoperative complications included transient hypocalcemia in 21 patients (41.17%), transient dysphonia in 3 patients (5.88%), hematoma in 2 patients (3.92%) and keloid scarring in 1 patient (2%). Histologic exam confirmed the diagnosis of thyroid cancer associated with Graves’ disease in 9 patients (17.6%): 8 papillary microcarcinomas and one papillary carcinoma. A radioiodine therapy was indicated in these cases.

Conclusions: If surgery is considered for definitive management, evidence-based criteria support total thyroidectomy as the surgical technique of choice for GD. Available evidence also supports surgery in the presence of severe endocrine Graves’ ophthalmopathy. Children with GD should be treated with an ablative strategy. Whether this is achieved by total thyroidectomy or RAI may still be debatable. Data on long-term cancer risk are missing; and until RAI has proven harmless in children, authors continue to recommend surgery in this setting. Postoperative complications are frequent and not negligible, hence the need for preoperative medical preparation.