Thyroidectomy Is Optimal Treatment for Graves' Disease

Abstract

Thyroidectomy continues to be the least common form of therapy for Graves' disease in the US, presumably based upon concerns about injuries to the recurrent laryngeal nerves and/or parathyroid glands. Concurrent and retrospective data were collected on 65 consecutive patients undergoing subtotal or total thyroidectomy for Graves' disease at one community-type hospital by one surgeon from 1992 to 2010. A total of 65 patients (50 women, 15 men) with a mean age of 38 years underwent subtotal (52.3%) or near total or total thyroidectomy (47.7%). Six patients (9.2%) had high lying or ischemic parathyroid glands reimplanted into the ipsilateral sternocleidomastoid muscle at the completion of the thyroidectomy, and none developed hypocalcemia. No injuries to the recurrent laryngeal nerve or external branch of the superior laryngeal nerve occurred. Seven patients (10.8%) had 1 parathyroid gland removed inadvertently during thyroidectomy, but none developed hypocalcemia. Nine patients (13.8%) were discharged from the hospital on supplemental calcium tablets for symptomatic or asymptomatic hypocalcemia (calcium < 7.5 mg/dL). Four patients were weaned off calcium tablets, and 5, all of whom had normocalcemia on supplementation, were lost to long-term follow-up. One patient had reopening of the cervical incision under the same anesthetic for stridor that was subsequently found to have been caused by bacterial tonsillitis, and 2 other patients had reoperations for a cervical hematoma (same day) and a reaction to hydrocodone with facial and cervical edema (tracheostomy, 11th day). No patient is known to have developed a recurrence of Graves' disease. Total thyroidectomy offers a rapid and complete cure for Graves' disease. Extensive thyroidectomy for Graves' goiters can be safely performed in a community-type hospital.