Subtotal Versus Total Thyroidectomy for Graves' Disease
Condition: Thyroid; Goiter
MeSH terms: Graves Disease
Study type: Interventional

Summary: 
      The extent of thyroid resection in Graves' disease remains controversial. The aim of this
      study was to evaluate long-term results of bilateral subtotal thyroidectomy versus total
      thyroidectomy in patients with Graves' ophthalmopathy.
    

Detailed description: 
      Graves' disease was first described in 1835. It is an autoimmune disorder caused by
      antibodies which bind to thyroid-stimulating hormone (TSH) receptors on the thyroid cell
      membrane. The overt clinical manifestation of this disease is usually characterised by
      presence of hyperthyroidism, thyroid associated ophthalmopathy and thyroid dermopathy.

      Treatment alternatives of Graves' disease include antithyroid medication, radioiodine therapy
      or thyroidectomy. The antithyroid medication is often used as the initial treatment for
      patients with newly diagnosed Graves disease in much of the world including Europe, Japan and
      South America. However, the use of radioiodine is the most common first-line treatment
      modality in the United States. Thyroidectomy should be considered in special circumstances
      such as in children and young adults, pregnant women, in the setting of ophthalmopathy, in
      the presence of thyroid nodules or big goitre, particularly when compressive symptoms, or
      substernal thyroid extension is diagnosed, as well as in cases of failed hyperthyroidism
      remission after antithyroid medication in patients refusing possible radioiodine treatment.

      The surgical management of Graves' disease remains controversial. Some authors support total
      thyroidectomy while others prefer various subtotal procedures. Most low-volume surgeons avoid
      performing total thyroidectomies for Graves' disease owing to the assumed higher complication
      rates. On the other hand, an increasing number of total thyroidectomies are currently
      performed in high-volume endocrine surgery units, and the indications for this procedure
      include not only high-risk thyroid cancer, but also Graves's disease and multinodular goiter.
      It has been shown that total thyroidectomy for Graves' disease lowers to almost zero the
      disease recurrence rate. However, other issues like unclear benefit for natural course of
      Graves' ophthalmopathy balanced against assumed higher risk of morbidity following more
      radical thyroid resections need to be clarified.

      We hypothesized that total thyroidectomy is superior to bilateral subtotal thyroidectomy for
      long-term control of Graves' disease. The aim of this study was to evaluate long-term results
      of bilateral subtotal thyroidectomy versus total thyroidectomy in patients with mild and
      active Graves' ophthalmopathy.
    

Intervention name(s): Bilateral subtotal thyroidectomy; Total thyroidectomy
Intervention type(s): Procedure; Procedure
Intervention description(s): The intervention consisted of bilateral subtotal thyroidectomy (leaving on both sides of the neck thyroid stumps of approximately 2 g of normal remnant tissue each).; The intervention consisted of total extracapsular thyroidectomy.
Other intervention name(s): BST; TT
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Graves' disease; total thyroidectomy; bilateral subtotal thyroidectomy; Graves' ophthalmopathy; morbidity rate