Surgical Experience of Hyperthyroidism / 대한이비인후과학회지

ABSTRACT

BACKGROUND AND OBJECTIVES: In the field of otolaryngology-head and neck surgery, surgical experience in hyperthyroidism is still limited with a lack of study on the subject. The author realized the necessity to study problems of early experience with the surgery. The purpose of this study is to elucidate significant prognostic factors in the surgery of Graves' disease and propose an optimum surgical method which is considered significant prognostic factors. SUBJECTS AND METHODS: Nineteen cases of Graves' disease and 4 cases of toxic nodule diagnosed and operated at the department of Endocrinology and department of Otolaryngology-Head and neck surgery of Kosin university Gospel Hospital, from November 1999 to February 2004 were retrospectively studied. To evaluate the safety of the surgery, preoperative management and postoperative complications were analyzed. The relations between postoperative thyroid function and surgical extent, lymphocytic infiltration, and TSH (Thyroid stimulating hormone) receptor binding inhibiting immunoglobulin were studied. Histological results of the postoperative thyroid tissue were also analyzed to detect any concurrent disease. RESULTS: Among the 9 cases of subtotal thyroidectomy in Graves' disease, 3 cases (33.3%) revealed postoperative hypothyrodism and 5 cases (55.6%) had normal thyroid function, while in 1 case (11.1%), hyperthyroidism recurred. There was no statistically significant relation between the degree of lymphocytic infiltration and postoperative thyroid function. Hyperthyroidism recurred 6 months postoperatively in one case with persistently elevated TSH receptor binding inhibiting immunoglobulin. No intraoperative or postoperative complication occurred in any of the cases. According to histopathologic results, 6 cases of Graves' disease were determined as diffuse thyroid hyperplasia and thyroid cancer was detected in 6 cases. CONCLUSION: This study revealed many advantages of surgical treatment in hyperthyroidism. High success rate and safe treatment without complication could be accomplished, and histologic diagnosis could be determined. Amounts of the remnant thyroid tissue and the level of TSH receptor binding inhibiting immunoglobulin seemed to be related to postoperative thyroid function. This study was performed with limited cases within a short period; thus, to preserve the remission state of postoperative thyroid function, studies on various factors affecting postoperative thyroid function are required.