Outcome of subtotal thyroidectomy and radioiodine therapy in Graves' disease.
- Author:
Suzette SOLIVA-LABRADOR
;
Cecilia A JIMENO
- Publication Type:Journal Article, Original
- Keywords:
Outcome, Subtotal ThyroidectomyRadioiodine TherapyGraves' Disease
- MeSH:
None
- From:
Philippine Journal of Internal Medicine
2008;46(4):151-158
- CountryPhilippines
- Language:English
-
Abstract:
Objectives: Primary objective: 1) To compare the outcome one year after between subtotal thyroidectomy and radioactive therapy based on the 1-year failure rate.Secondary objectives: 1) To determine the thyroid function status of patients a year after each treatment modality; 2) To know the risk factors associated with treatment failure; 3) To determine the rate of complications for each treatment modality.Methods: Retrospective Cohort StudyInclusion Criteria: 1) Adults (> 18 years old) patients seen at the PGH-OPD thyroid Clinic from 1990 to 2004 diagnosed to have Graves' disease who underwent either thyroidectomy or radioiodine therapy.Exclusion Criteria: 1) patients with concomitant thyroid CA; 2) Patients who underwent both treatment modalities. Statistical analysis used were means, standard deviation, Pearson chi2 and logistic regression analysis.Results: Of the 182 patients, 60 belonged to the thyroidectomy group and 122 in the radioiodine group. There were more females than male with the ratio of M:F in both groups 1:6. There is a higher 1-year failure rate seen in patients who underwent radioiodine (20 percent) compared to those who underwent thyroidectomy (3 percent). There were more patients who became hypothyroid in the thyroidectomy group (73 percent) compared to the radioiodine group (56 percent). The percentage of patients becoming euthyroid is comparable for both treatment modalities. There were more patients still persistently hyperthyroid one year after radioiodine therapy. The onset of hypothyroidism for the thyroidectomy group in majority of patients is on the 2nd month after the intervention while it is 3-4 months after radioiodine therapy. There was no complication present following radioiodine therapy but in those who underwent thyroidectomy, one had recurrent laryngeal nerve palsy and two had permanent hypoparathyroidism. Overall, there is a complication rate of 5 percent for patients who had subtotal thyroidectomy.Conclusions: Radioiodine therapy has a higher failure rate (20 percent) compared to thyroidectomy (3 percent) but there is a higher risk for hypothyroidism in subtotal thyroidectomy (73 percent) than in radioiodine therapy (56 percent). Although radioactive iodine has a higher failure rate it can still be an option as a definitive therapy in Graves' disease because of its lower rate of hypothyroidism as compared to thyroidectomy.Complication rate was higher in the subtotal thyroidectomy group (5 percent) and none in the radioiodine group. Over-all success of surgery is not impressive because of the high rate of hypothyroidism and the presence of complications.
