Total Versus Subtotal Thyroidectomy in Graves' Disease At AUH

Study Overview
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Brief Summary
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The main aim of work is to compare between subtotal and total thyroidectomy intra and postoperatively to identify which technique is better for patient of graves disease

Detailed Description
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Graves' disease is an autoimmune disease that affects the thyroid gland[1] and it's the most common cause of hyperthyroidism. [2] Treatment of Graves' disease includes antithyroid drugs ; radioiodine ; and thyroidectomy . patients with Graves' hyperthyroidism can be treated with any of these treatment options. There is a wide geographic variation in the choice of therapy.[3] Medical treatment with antithyroid drugs is often accepted as first-choice modality in Europe, followed by radioiodine in case of recurrence. Although surgery offers the advantage of quick control and low morbidity in experienced hands, it is infrequently recommended as initial treatment. Therapy with radioiodine is the most common treatment in the United States, while antithyroid drugs and/or thyroidectomy are used more often in Europe, Japan, and most of the rest of the world.recent literature shows that the relapse rate was the highest among patients who received antithyroid drugs (40%) as compared to those who received radioiodine (21%) or Surgery (5). [4] Two different surgical techniques are used for the treatment of Graves' hyperthyroidism: a total thyroidectomy (TT) in which the entire gland is removed and a subtotal thyroidectomy (STT) , in which most of the gland is removed leaving a small unilateral or bilateral remnant in situ about 4-5 grams. Although thyroidectomy has been broadly considered as a viable alternative theapy for patients with Graves' disease , the resection extent and remnant size of thyroid gland remains controversial.[6] Although total thyroidectomy has a lower recurrence rate it has raised a concern that a more radical operation would increase the complications.[7] we intend to perform this analysis based on the published literatures of randomized controlled trials to evaluate the specific risks of thyroid surgery including recurrent hyperthyroididm , post-operative bleeding , recurrent laryngeal nerve injury , hypoparathyroidism and opthalmopathy progression.

Official Title
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Total Versus Subtotal Thyroidectomy in Graves' Disease : A Randomized Controlled Trial

Conditions
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Thyroid Goiter

Intervention / Treatment
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* Procedure: total thyroidectomy
* Procedure: subtotal thyroidectomy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients diagnosed clinically, biochemically and immunologically with Graves' disease who will undergo thyroidectomy at general surgery department in AUH. Exclusion Criteria: 1- previous thyroid or parathyroid surgery. 2- recurrent hyperthyroidism after radioiodine therapy. 3- preoperative recurrent laryngeal nerve palsy. 4- patients unfit for operation. 5- inability to comply with the follow-up protocol. 6- suspicious thyroid nodules.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: TT group<br> | Procedure: total thyroidectomy<br>* a total thyroidectomy (TT) in which the entire gland is removed<br>|
| Active Comparator: ST group<br> | Procedure: subtotal thyroidectomy<br>* subtotal thyroidectomy (STT) , in which most of the gland is removed leaving a small unilateral or bilateral remnant in situ about 4-5 grams.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| comparison between total thyroidectomy vs subtotal thyroidectomy in graves' disease | Prevlance of recurrent hyperthyroidism | baseline | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| comparison between total thyroidectomy vs subtotal thyroidectomy in graves' disease | Postoperative hypocalcemia and hypoparathyroidism. | baseline |