Total Thyroidectomy Is Superior to Subtotal Thyroidectomy for Management of Graves' Disease in the United States

In the United States, Graves' disease is most commonly treated with radioiodine, yet thyroidectomy remains an important option for correcting hyperthyroidism. In many countries, limited access to thyroid hormone makes subtotal thyroidectomy the procedure of choice. In the United States, where levothyroxine is widely available, we hypothesized that total (TT) or near-total thyroidectomy (NT) is superior to subtotal thyroidectomy (ST) for long-term control of Graves' disease. A retrospective review of patients who underwent ST, NT, or TT for Graves' disease between 1990 and 2008 was conducted. Differences in rates of disease recurrence were assessed by analysis of variance (ANOVA). Rates of parathyroid autotransplantation, complications, gland weight, and final pathology were determined. A total of 136 patients with Graves' disease were treated with thyroidectomy. Average age was 36.4 +/- A 11.3 years (range: 16-81 years) and 88% were female. From 1990 to 1994, 10 patients underwent ST and 6 had NT. Since then, all patients have undergone TT (n = 120). There was a significantly higher rate of recurrence for ST (30%) compared to NT (0%; P = 0.15) and TT (0%; P < 0.0001). Parathyroid autotransplantation was performed in 36 (26.5%) patients, only 2 of whom underwent ST or NT. Transient postoperative hypocalcemia was more common after TT (P = 0.04). No patient in any group had permanent hypoparathyroidism. Two TT pts had transient recurrent laryngeal nerve palsy. Subtotal thyroidectomy resulted in 30% long-term failure to correct Graves' hyperthyroidism. We saw no recurrences and no increase in postoperative complications in the TT group. We feel that TT is safe and superior to ST for management of Graves' disease in the United States.