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Thyroidectomy for Selected Patients With Thyrotoxicosis
Elizabeth A. Mittendorf, MD;
Christopher R. McHenry, MD
Arch Otolaryngol Head Neck Surg. 2001;127:61-65.
Objective To examine the indications for operation and the frequency, efficacy,
and outcome of surgical therapy for thyrotoxicosis.
Methods The medical records of all patients who underwent thyroidectomy between
1990 and 1998 were reviewed. Operative indications, laboratory evaluations,
extent of thyroidectomy, pathologic findings, and morbidity and mortality
were determined for patients with thyrotoxicosis.
Results Of the 347 patients who underwent thyroidectomy, 54 (16%) had thyrotoxicosis,
secondary to Graves' disease (32 patients), toxic multinodular goiter (18
patients), thyroiditis (2 patients), or amiodarone (2 patients). The indications
for operation were compressive symptoms or substernal extension or both (35
patients), patient preference (12 patients), thyrotoxicosis (4 patients),
or a dominant nodule (3 patients). Most patients received pharmacological
preparation, followed by total (32 patients), near-total (13 patients), subtotal
(8 patients), or unilateral (1 patient) thyroidectomy. The initial 8 patients
with Graves' disease underwent subtotal thyroidectomy, and after a mean 28-month
follow-up, 1 was euthyroid; 2, hyperthyroid; and 5, hypothyroid. Associated
carcinoma was present in 4 (7%) of the 54 patients. Symptomatic hypocalcemia
occurred in 10 patients (19%), with a mean free thyroxine level of 60.49 ±
16.09 pmol/L vs 40.41 ± 19.56 pmol/L (4.70 ± 1.25 ng/dL vs 3.14
± 1.52 ng/dL) in 25 patients (46%) with asymptomatic hypocalcemia (P<.05). Vocal cord paresis and a hematoma requiring
operative evacuation occurred in 1 patient each. There was 1 mortality in
a patient with amiodarone-induced thyrotoxicosis.
Conclusions Massive thyroid enlargement with compressive symptoms, a dominant nodule,
and patient preference are indications for surgical treatment of thyrotoxicosis.
Near-total or total thyroidectomy is safe and more effective than subtotal
thyroidectomy in preventing recurrence and should be considered in most patients
referred for surgical treatment of thyrotoxicosis. Transient postoperative
hypocalcemia is common and is related to the severity of thyrotoxicosis.
From the Department of Surgery, MetroHealth Medical Center, Case Western
Reserve University School of Medicine, Cleveland, Ohio.
Corresponding author and reprints: Christopher R. McHenry, MD, Department
of Surgery, MetroHealth Medical Center, Case Western Reserve University School
of Medicine, 2500 MetroHealth Dr, Cleveland, OH 44109-1998.
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