그레이브스병의 수술에서 적절한 절제 범위

Abstract

Background and Objectives Thyroidectomy for Graves’ disease is a rapid, safe, highly successful treatment modality. Also thyroidectomy allows pathological examination for diagnosis of suspected cancer. However, the extent of thyroidectomy in Graves’ disease is still controversial. The aim of this study is to evaluate the appropriate surgical extent by comparing the postoperative outcomes of two groups of patients with Graves’ disease who underwent total or less than total thyroidectomy. Subjects and Method We carried out a retrospective review of 33 patients who underwent thyroidectomy for Graves’ disease from January 2001 to December 2010. We investigated the postoperative thyroid hormone function and complication rate according to the extent of thyroidectomy. Results Among the 33 patients with Graves’ disease, 19 patients underwent total thyroidectomy, six patients bilateral subtotal thyroidectomy (BST) and eight patients lobectomy and contralateral subtotal lobectomy (LCSL). Postoperative hypothyroidism, euthyroidism, and hyperthyroidism occurred in 27 (81.7%), 2 (6.1%) and 4 (12.2%) patients, respectively. Postoperative recurrent hyperthyroidism was observed in 2 (33.3%) patients of BST and in 2 (25.0%) of LCSL. One patient was found with permanent hypoparathyroidism, and two with transient vocal cord paralysis. According to histopathologic report, nine patients were accompanied with thyroid cancer. Conclusion Thyroidectomy for Graves’ disease has high success rate, low recurrence rate and low complication rate. In terms of surgical extent, total thyroidectomy is a more appropriate procedure because of its low recurrence of hyperthyroidism.