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Surgery. 2014 Mar;155(3):529-40. doi: 10.1016/j.surg.2013.10.017. Epub 2013 Oct 16.

A systematic review and meta-analysis of total thyroidectomy versus bilateral subtotal thyroidectomy for Graves' disease.

Author information

  • 1Department of General Surgery, Misericordia e Dolce Hospital, Prato, Italy. Electronic address: fferoci@yahoo.it.
  • 2Department of General Surgery, Misericordia e Dolce Hospital, Prato, Italy.
  • 3Department of Nuclear Medicine, Misericordia e Dolce Hospital, Prato, Italy.
  • 4Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy.

Abstract

BACKGROUND:

Our aim was to perform a meta-analysis of high-quality published trials, randomized and observational, comparing total thyroidectomy (TT) and bilateral subtotal thyroidectomy (ST) for Graves' disease.

METHODS:

All studies published from 1970 to August 2012 were identified. All randomized controlled trials (RCTs) were included. Selection of high-quality, nonrandomized comparative studies (NRCTs) was based on a validated tool (Methodological Index for Nonrandomized Studies). Recurrent hyperthyroidism during follow-up, progression of ophthalmopathy, postoperative temporary and permanent hypoparathyroidism, and permanent recurrent laryngeal nerve (RLN) palsy were compared using odds ratios (ORs).

RESULTS:

Twenty-three studies were included (4 RCTs and 19 NRCTs) compromising 3,242 patients (1,665 TT, 1,577 ST). TT was associated with a decrease in recurrent hyperthyroidism (P < .00001; OR, 0.10; 95% confidence interval [CI], 0.06-0.18), but with an increase in both temporary (P < .00001; OR, 2.70; 95% CI, 2.04-3.56) and permanent hypoparathyroidism (P = .005; OR, 2.91; 95% CI, 1.59-5.32). Progression of ophthalmopathy (P = .76; OR, 0.90; 95% CI, 0.48-1.71) and permanent RLN palsy (P = .82; OR, 0.91; 95% CI, 0.41-2.02) were similar.

CONCLUSION:

TT offers a better chance of cure of hyperthyroidism than bilateral ST and can be accomplished safely with only a small increase in temporary and permanent hypoparathyroidism.

Copyright © 2014 Mosby, Inc. All rights reserved.

PMID:
24230962
[PubMed - indexed for MEDLINE]
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