Total Thyroidectomy as a Method of Choice in the Treatment of Graves' Disease

Analysis of 1432 Patients

Toplica Bojic; Ivan Paunovic; Aleksandar Diklic; Vladan Zivaljevic; Goran Zoric; Nevena Kalezic; Vera Sabljak; Nikola Slijepcevic; Katarina Tausanovic; Nebojsa Djordjevic; Dragana Budjevac; Lidija Djordjevic; Aleksandar Karanikolic


BMC Surg. 2015;15(39) 

In This Article


Graves' disease (GD) represents an autoimmune disease of the thyroid gland, which is manifested by excessive production of hormones of the thyroid gland and is a common cause of hyperthyroidism. GD is primarily treated by anti thyroid drugs, and only in the case of failure of this method of treatment are other types of therapy, such as the use of radioactive iodine, taken into account.[1] In some countries, such as the United States, total thyroidectomy is recommended only after treatment with radioactive iodine. In Scandinavia, however, surgery with a low complication rate plays an important role in the treatment of GD.[2,3]

Surgical treatment is applied after exhausting other treatment modalities, and represents a definitive treatment where the reasons for surgery are various. The rate of relapse after surgery is significantly lower than for treatment with radioiodine, or anti thyroid drugs.[4,5] Antithyroid drugs on one hand have good tolerance, but the rate of recurrence of hyperthyroidism is up to 69% after termination of the treatment.[6] Radio ablation is a cost effective method, good for patients at risk for surgery, but in order to achieve euthyroidism it takes up to 6 month.[7]

Surgical interventions, on the other hand, carried out in patients with significant goitre and ophthalmopathy give the fastest results and lead to the rapid regression of the symptoms of hyperthyreosis.[8]

Surgical treatment of GD achieves a quick and efficient therapeutic effect and interventions performed by an experienced surgeon are considered a safe procedure.[1] The surgical treatment of GD includes several modalities of surgical operations such as bilateral subtotal lobectomy (STT), unilateral total lobectomy and contralateral subtotal lobectomy - Dunhill's operation (D) and total or near total thyroidectomy (TT).

The aim of our work was to analyze the results of surgical treatment of patients with GD, the frequency of microcarcinoma and carcinoma in patients who underwent surgery for GD, as well as to compare surgical complications (postoperative bleeding, postoperative hypoparathyroidism, lesions of the recurrent laryngeal nerve) in relation to the various types of operations performed for GD.