Surgical Management of Graves’ Disease over a 25-year Period in a Single Institution: Comparison of Outcomes between Subtotal Thyroidectomy and Total Thyroidectomy

Introduction: Surgery is offered to patients with Graves’ disease (GD) refractory to medical or radio-iodine therapy. Total thyroidectomy (TT) has been shown to lower recurrence rates of hyperthyroidism but subtotal thyroidectomy (ST) is thought to be associated with lower risk of postoperative complications. The aim of this study was to compare the postoperative outcomes of TT vs ST in the Singaporean population and identify risk factors that might predispose to treatment failure after ST. Materials and methods: This is a retrospective review of consecutive patients who underwent surgery for GD at a single institution in Singapore. Patients who underwent thyroid surgery for GD between January 1991 and December 2015 were included in the study. The primary outcomes studied were rates of recurrent hyperthyroidism, hypocalcemia, recurrent laryngeal nerve injury, and length of stay postsurgery. The secondary outcome was to compare whether preoperative thyroid function and antibody levels predicted for treatment failure post-ST. Results: Over a 25-year period, 79 patients underwent ST and 38 patients underwent TT. The rate of hyperthyroidism relapse post-ST was 20.3% compared with 0% post-TT (p < 0.01). There was no difference between the length of stay, or recurrent laryngeal nerve injury between patients who underwent ST compared with TT. Preoperative antibody levels and biochemical hyperthyroidism did not predict treatment failure after ST. Conclusion: Total thyroidectomy is a more definitive surgical procedure for patients with GD refractory to medical therapy with lower risk of disease relapse and similar temporary and long-term risk of complications when compared with ST.