The authors disagree with an earlier expert panel report that cited insufficient evidence to treat patients with TSH levels of 0.1–0.45 mU/L and recommended treating only those with TSH levels below 0.1 mU/L (JAMA 2004;291:228–38).
Thyroidectomy Safe for Grave's
Total thyroidectomy can be performed more safely than many clinicians realize, and offers more durable results for people with Grave's disease than do antithyroid drugs or radioiodine, according to Dr. Kaare J. Weber of Mount Sinai School of Medicine, New York, and his associates.
The researchers reviewed the records of all 48 patients who underwent total thyroidectomy for Grave's disease at their hospital between 1993 and 2005. All but 7 of the patients were women, and the mean age was 40 years.
After a mean of 40 months follow-up post thyroidectomy, there were no recurrences of hyperthyroidism. In contrast, relapse rates of 20%–75% are cited in the literature for medical therapy, Dr. Weber and his associates said (Am. J. Surg. 2006;191:400–5).
Of the 20 patients who had mild or severe ophthalmopathy before surgery, 11 showed marked improvement or resolution of eye disorders and the remaining 9 showed either improvement or stabilization. In contrast, radioiodine treatment has been associated with the onset or exacerbation of ophthalmopathy, they said.
Eight patients (17%) were found to have papillary cancer of the thyroid at surgery. “These patients would not have received appropriate treatment for their coexisting cancer if they were treated only with antithyroid drugs and/or radioiodine,” the investigators noted.
No patients suffered permanent laryngeal nerve injury from the procedure. Complications included three cases of transient hypocalcemia and one case of temporary right vocal cord paralysis. Only one patient developed permanent hypoparathyroidism, and that case “followed a previous failed [thyroid] exploration at another institution,” they said.
These results demonstrate that total thyroidectomy now can be performed safely, with little of the morbidity and mortality that occurred when the procedure was first developed years ago. In addition, thyroidectomy addresses potentially cancerous nodules, as medical and radioiodine therapies do not, they said.