Alternating from subtotal thyroid resection to total thyroidectomy in the treatment of Graves' disease prevents recurrences but increases the frequency of permanent hypoparathyroidism.

PURPOSE: This study aims to compare the results of three different surgical techniques in the treatment of Graves' disease.

METHODS: All patients operated on due to Graves' disease at a single institution between 1985 and 2009 were followed up for a median time of 152 months. The same endocrine surgeon operated altogether 265 patients; 111 with bilateral subtotal thyroid resection, 65 with lobectomy + unilateral subtotal resection (Dunhill's operation) and 99 with total thyroidectomy.

RESULTS: Recurrence of thyreotoxicosis was seen in 11 (9.9%) patients operated on with bilateral thyroid resection, in two (3.1%) of those operated on with Dunhill's method and in none treated with total thyroidectomy. Permanent hypoparathyroidism was observed in 6% of the patients with total thyroidectomy, in 0.9% of those operated with bilateral subtotal resection and in none of the patients with Dunhill's procedure (p < 0.001). The frequency of permanent paresis of one recurrent laryngeal nerve was 2%, 0% and 1.5%, respectively, in the three different groups. At follow-up, thyroxine supplementation therapy was given to 81 (73%) of the patients treated with bilateral subtotal resection, to 58 (89%) of those treated with Dunhill's operation and to all of those treated with total thyroidectomy.

CONCLUSIONS: It is concluded that surgical treatment of Graves' disease with Dunhill's procedure, leaving a remnant of 1-2 g, seems to minimize the risks of both recurrences and permanent hypoparathyroidism.