The value of total thyroidectomy as the definitive treatment for Graves' disease: A single centre experience of 594 cases

Purpose: Thyroidectomy is the preferred approach as the definitive treatment for Graves' disease. The outcomes for total thyroidectomy in a large series of 594 patients, who were observed in the last decade, will be presented in this study. Methods: The study concerned a retrospective review of 594 patients, undergoing a total thyroidectomy for Graves' disease. The incidence of complications and outcomes on hyperthyroidism and correlated symptoms resolution were also evaluated. Results: The mean age of the patients was of 44.7 +/- 12.7 years and 456 patients (76.7%) were females. The mean gland weight was 67.3 +/- 10.8 g (range: 20-350 g) and, in 397 patients (66.8%), the gland weighed > 40 g. The mean operative time was 125 +/- 23.1 min (range: 65-212 min). Temporary and permanent hypocalcaemia developed in 241 (40.6%) and 3 patients (0.5%), respectively. Temporary and permanent recurrent laryngeal nerve palsy were recorded in 31 (5.2%) and 1 patients (0.16%) respectively. No patient developed a thyroid storm. On multivariate analysis, patient age <= 50 years (Odds ratio: 1; 95% Confidence Interval: 0.843-0.901) and thyroid weight > 40 g (Odds ratio: 1; 95%, Confidence Interval: 0.852-0.974), were mainly associated with the occurrence of complications. Conclusion: This high-volume surgeon experience demonstrates that total thyroidectomy is a safe and effective treatment for Graves' disease. It is associated with a very low incidence rate of post-operative complications, most of which are transitory; therefore, it offers a rapid and definitive control of hyperthyroidism and its related symptoms.