Surgical treatment of Grave's disease

Seven men and 81 women were operated on for Graves' disease. Their median age was 33 years. Eleven patients underwent a bilateral subtotal lobectomy; 77 patients underwent a complete lobectomy with contralateral partial lobectomy. Forty-seven patients were treated before 1981. In these patients, the weight of the thyroid remnant was estimated empirically between 5 and 12 g. In the 41 patients treated since 1981, the remnant weight was estimated at 5 g by comparative weighing. There were no postoperative deaths. Functional results were established in 83 patients with an average follow-up of 50 months (range 12 to 156 months), with control of vocal cord mobility demonstrated by indirect laryngoscopy in 66 patients. Hormonal determinations were carried out in 74 patients. There were no cases of permanent hypoparathyroidism. Three patients (4.5 percent) had unilateral vocal cord dysfunction. Twelve patients (14.5 percent) had clinical and biologic hypothyroidism, which occurred within 1 year postoperatively in 11 cases. Seven patients (8.3 percent) had latent hypothyroidism only discovered by hormonal determinations. Fifteen patients (17.8 percent) had recurrent hyperthyroidism, 6 of whom were diagnosed by hormonal determinations. The actuarial recurrence rate increased progressively up to the sixth postoperative year. The only predictive factor for recurrence was the type of operation. Patients who underwent a bilateral subtotal lobectomy had more recurrences than patients who underwent a complete lobectomy with partial contralateral lobectomy (p less than 0.01). These results suggest that patients should be followed closely for many years and should undergo hormonal determinations regularly, as some recurrences can occur 5 years or more after operation with very few symptoms.