Extent of Surgery in the Surgical Treatment of Graves' Disease: Subtotal vs. Total Thyroidectomy and Comparison of the Long-term Results.

Objectives: The extent of the surgical treatment for Graves' disease (GD) has evolved from subtotal to total thyroidectomy. This study analyzes the extent of thyroidectomy for GD and its impact on recurrence and complications, focusing on the relationship between remnant thyroid tissue and recurrence in subtotal thyroidectomy, comparing our current approach with historic data spanning over three decades.

Methods: A retrospective analysis of 427 GD patients who underwent surgery at a tertiary hospital from 1988 to 2022. Patients were categorized into total/near-total thyroidectomy (TT, n=302) and subtotal thyroidectomy (ST, n=125). The groups were compared for demographics, postoperative complications, and recurrent hyperthyroidism rates. ROC analysis determined the remnant cut-off value for recurrence in the ST group.

Results: Age and sex were similar across groups. Recurrent hyperthyroidism was found in 8% of ST patients but none in the TT group (p<0.001). Transient hypoparathyroidism was higher in the TT group (16.9% vs. 0.8%; p<0.001). Persistent hypoparathyroidism and vocal cord paralysis rates were comparable. ST patients with recurrence had more remnant tissue (5.3±0.94 g vs. 3.4±1.34 g; p<0.01). The remnant tissue cut-off for predicting recurrence was 4 g (<4 g: 0%, ≥4 g: 17.8%; p<0.001).

Conclusion: Total thyroidectomy has lower recurrence rates than subtotal thyroidectomy without significantly increasing long-term complications. Remnant tissue larger than 4 g in subtotal thyroidectomy increases the risk of recurrence.