Subtotal thyroidectomy under acupuncture anesthesia was successful for graves' disease. The complications in early postoperative period were only 8.77% and no mortality rate. A study on 456 patients who were performed subtotal thyroidectomy between 1993 and 1995 has shown the early complications were as follows: (1) Thyroid storm in early postoperative period were 6 patients (1.31%). (2) Post - thyroidectomy hemorrhage were 3 patients (0.65%). (3) Hypoparathyroidism: 12 patients (2.63%). (4) Postoperation Acute respiratory failure postoperative was 9 patients (1.97%). (5) Recurrent laryngeal nerve paralysis was 10 patients (2.18%).
Graves Disease ; surgery, Postoperative Complications ; surgery

From 25 January 2002 to 11 May 2004, there were 200 patients operated at National Hospital of Endocrinology for treatment of Grave’s disease. Ratios of male/female were approximately 2/8. Most of them were in the range of age from 20 to 49 years old (81.0%). The operative indication included the euthyroid cases. The preoperative preparing by Lugol solution, prednisolon was necessary. The techniques of operation included: total thyroidectomy for 14 patients (7%), near total thyroidectomy with small amount of thyroid tissue left at the superior pole for 9 (4.5%), and with posterior wall remnant for 177 (88.5%). The total thyroidectomy was performed for patients who were accompanied with nodules, were allergic to synthesis anti-thyroid drugs, or severe ophthalmopathy. There were no mortality as well as thyroid storm and tarchycardia after operation. There were 3 cases had to be reoperated due to hemorrhage, 3 cases of transient hoarseness (1.5%), 19 cases of transient hypocalcaemia (9.5%).Only 64 patients came to hospital for reexamination at 3 months after operation. Among them, there were 58 euthyroid cases (90.7%) with FT4 in normal limit
Graves Disease, Operations Research, Therapeutics, Surgery

This report presents the use of various surgical treatment modalities in patients who were diagnosed as having thyroid ophthalmopathy. The records of 53 patients who received surgery because of thyroid ophthalmopathy at the Department of Ophthalmology, Yonsei University College of Medicine between Sept. 1996 and Jan. 2000 were retrospectively evaluated. Among the 53 patients, there were 30 females and 23 males. The mean ages of the patients were 40.8 +/- 17.1 years. Orbital wall decompression (52.8%) was the most frequently performed surgery followed by lid surgery (49.1%) and strabismus surgery (26.4%). Only one type of surgery was performed on 86.8% of the patients while 13.2% received more than one type of surgery. Among the many different types of surgeries possible in patients that have thyroid ophthalmopathy, orbital wall decompression, lid surgery, and strabismus surgery are the most commonly used surgical methods for treatment.
Adult ; Decompression, Surgical ; Eyelids/surgery ; Female ; Graves' Disease/*surgery ; Human ; Male ; Middle Age ; *Ophthalmologic Surgical Procedures ; Orbit/surgery ; Strabismus/surgery

OBJECTIVETo discuss the method, the advantages and disadvantages of endoscopic thyroidectomy.

METHODSEndoscopic thyroidectomy via areola of breasts approach was performed in 150 patients, including 41 cases of thyroid adenoma, 64 cases of nodular goiter, 40 cases of Graves' disease, and 5 cases of thyroid carcinoma.

RESULTSThe endoscopic thyroidectomy was successfully carried out in 144 cases, including tumor dissection in 32 cases, one lobe partial thyroidectomy in 54 cases, two lobe partial thyroidectomy in 19 cases, subtotal thyroidectomy in 37 cases of Graves' disease, and radical thyroidectomy in 2 cases of thyroid carcinoma. The operative time length ranged from 50 to 270 min (mean 80 min). There were no complications such as damage to recurrent laryngeal nerve or parathyroid glands. Postoperative hospital stay ranged from 3 to 7 days (mean 4 days). The post-operative following-up for 1 approximately 13 months indicated that all the patients were satisfied with the cosmetic results and the same curative effects as conventional surgery were obtained. However, the operations were converted into open surgery in 6 cases.

CONCLUSIONSEndoscopic thyroidectomy is a safe and effective method of thyroid surgery. Since all the minimal incisions are on concealed parts of the body, the obvious cosmetic effect of this method is guaranteed.

Adolescent ; Adult ; Endoscopy ; Female ; Follow-Up Studies ; Graves Disease ; surgery ; Humans ; Male ; Thyroidectomy ; methods ; Treatment Outcome

OBJECTIVETo assess the feasibility and relevant applying techniques of total thyroidectomy for Graves' disease with a modified Miccoli's approach.

METHODSForty-two patients with Graves' disease consecutively received the radical operation from June 2002 to December 2004.The modification includes: (1) Incision extending according to the degree of lobe enlargement (3-6 cm, average 4 cm); (2) A space maintain-regulating device was used to change dimensionally the volume of working space (mainly height) when specific manipulation needed; (3) A volume-reducing resection step was performed for the gland with degree III hyperplasia by cutting off the middle-inferior part of the lobe prior to endoscopic lobectomy. The approach was designed to mainly use ultrasonically-activated scalpels, with suction-dissector or others as supplementary instruments. During the operations, a method of "sequenced dissect-coagulate-cut" was employed to directly divide all branches of thyroid vessels without ligation or application of hemoclips.

RESULTSAll procedures were completed successfully. None of them were converted to open surgery due to uncontrolled bleeding or severe postoperative hematoma. No severe complications occurred, except 2 cases who suffered from temporary hoarseness.

CONCLUSIONTotal thyroidectomy for Graves' disease can be safely performed with the modified Miccoli's approach by using ultrasonic scalpel and the space maintain-regulating device. Application of these adaptive reforms can obviously reduce the difficulties in manipulation, and thus, make the usage of this minimally invasive design also clinically possible for even radical treatment of the gland.

Adolescent ; Adult ; Endoscopy ; Female ; Graves Disease ; surgery ; Humans ; Male ; Middle Aged ; Thyroidectomy ; methods

Catheter Ablation ; Graves Disease/surgery* ; Humans ; Microwaves/therapeutic use* ; Radiofrequency Ablation ; Treatment Outcome ; Ultrasonography ; Ultrasonography, Interventional

OBJECTIVE: To investigate the surgical method of inferomedial orbital decompression under nasal endoscope for malignant hyperthyroid exophthalmos and surgical effect. METHOD: Twenty one cases (27 eyes) of malignant hyperthyroid exophthalmos with poor visual function and appearance received part of inferomedial orbital wall excision. RESULT: The patients were followed up for 6 to 12 months after surgery. Ocular protrusion recessed 2-6 mm and averaged 4.85 mm in all cases. Visual acuity increased in 17 eyes, remained the same in 9 eyes and decreased in 1 eye. Diplopia appeared in 5 cases after surgery and disappeared in 3 months. CONCLUSION Part of inferomedial orbital wall excision under nasal endoscope has the advantage of clear visual field, accurate excision, little hurt and complications. It is an effective method for malignant hyperthyroid exophthalmos.
Adult ; Endoscopy ; Female ; Graves Disease ; surgery ; Humans ; Male ; Middle Aged ; Nose ; surgery ; Orbit ; surgery ; Treatment Outcome ; Young Adult

One hundred patients who underwent bilateral subtotal thyroidectomy for Graves' disease between January 1980 and September 1984 have been evaluated. The observation period ranged from 5 to 9 years, the average being 6.2 years. Postoperative thyroid function was evaluated with T3, T4 and TSH and compared with their clinical manifestations. Eighty-two patients became euthyroid, 14 patients had recurrence and 4 patients developed hypothyroidism. The thyroid hormone level of euthyroid patients were in an unstable state up to 5 years after the operation. Sixteen variables which might influence the postoperative recurrence and hypothyroidism were analyzed but no statistically significant factors were determined, although recurrences were found frequently in patients over 30 years, the patients with lower infiltration of lymphocytes and absent of fibrosis of thyroid tissue. The results obtained in the present study suggest that mean 6.0 gm of remnant thyroid is suitable for maintaining euthyroidism postoperatively in a majority of patients. In addition, patients should be followed closely for many years and should undergo hormonal determination periodically because recurrence and hypothyroidism can occur at 5 years or more after the operation.
Adolescent ; Adult ; Chi-Square Distribution ; Female ; Follow-Up Studies ; Graves' Disease/physiopathology/*surgery ; Human ; Logistic Models ; Male ; Middle Age ; Prognosis ; Support, Non-U.S. Gov't ; Thyroid Gland/*physiopathology ; *Thyroidectomy/methods

Thymic hyperplasia is frequently observed in Graves' disease. However, detectable massive enlargement of the thymus is rare, and the mechanism of its formation has remained elusive. This case showed dynamic changes in thymic hyperplasia on serial computed tomography images consistent with changes in serum thyrotropin receptor (TSH-R) antibodies and thyroid hormone levels. Furthermore, the patient's thymic tissues underwent immunohistochemical staining for TSH-R, which demonstrated the presence of thymic TSH-R. The correlation between serum TSH-R antibody levels and thymic hyperplasia sizes and the presence of TSH-R in her thymus suggest that TSH-R antibodies could have a pathogenic role in thymic hyperplasia.
Adult ; Female ; Graves Disease/*complications/surgery/therapy ; Humans ; Male ; Receptors, Thyrotropin/blood ; Thymus Gland/diagnostic imaging ; Thymus Hyperplasia/*diagnostic imaging/etiology/immunology ; Thyroid Hormones ; Thyroidectomy ; Thyrotropin/blood ; Tomography, X-Ray Computed ; Young Adult