Changing trend in surgical indication and management for Graves' disease

Abstract

BACKGROUND: Although thyroidectomy for Graves' disease (GD) is well established, surgical indications remain less well defined. This study aimed to evaluate the changes in surgical indication, type of resection, and surgical outcomes at a single institution. METHODS: A total of 346 patients who underwent thyroidectomy for GD were divided into 2 time periods: period 1 (1995-2001) and period 2 (2002-2008). Their surgical indication, type of resection, and surgical outcomes were compared. RESULTS: Patients in the earlier period were significantly younger, suffered more previous relapses, and were on a longer duration of antithyroid drugs before surgery. Graves' ophthalmopathy and refusal for radioactive iodine were the indications that changed significantly between the 2 periods. Total/near-total thyroidectomy was performed more commonly and resulted in a higher temporary hypoparathyroidism rate in the latter period (P < .001). CONCLUSIONS: Over the study period, significant changes in surgical indication, type of resection, and surgical outcomes were noted. Graves' ophthalmopathy became one of the most common surgical indications. Total thyroidectomy became the preferred surgery but that resulted in a higher temporary hypoparathyroidism rate.