Abstract
Prerequistes for surgical treatment of Graves' disease are that it can be done safely and that it is associated with a low incidence of recurrent hyperthyroidism. Early recurrence is especially undesirable. We studied 728 patients with Graves' disease treated by subtotal thyroidectomy using multivariate analysis in order to determine the factors related to early recurrence. The following factors were analyzed: age, sex, duration of medical treatment, weight of resected thyroid tissue, thyroid remnant size, preoperative level of thyroid-stimulating hormone (TSH) binding inhibitory immunoglobulin (TBII), and antimicrosomal hemagglutination antibody (MCHA). “Early recurrence” was defined as TSH suppression observed within the first year after surgery and continuing for at least 6 months. A total of 106 patients (14.6%) had early recurrence. Statistical analyses were performed by the chi-square test for univariate analysis and a logistic model for multivariate analysis. Significant factors were thyroid remnant size, MCHA, and TBII. These results indicated that TBII and MCHA are related to early recurrence of hyperthyroidism, and smaller remnant size is recommended for patients with a high MCHA titer or a high TBII level (or both) in order to avoid early recurrence.
Résumé
Le traitement chirurgical de la Maladie de Basedow se doit d'être non seulement sûr mais doit aussi éviter un taux excessif de récidive d'hyperthyroïdie. La récidive précoce est particulièrement fâcheuse. Nous avons étudié 728 patients atteints de Maladie de Basedow, traités par thyroïdectomie subtotale, en analyse multifactorielle, de façon à détecter les facteurs éventuels de récidive précoce. On a analysé les facteurs suivants: âge, sexe, durée du traitement médical, le poids del la pièce réséquée, la taille du moignon restant, les niveaux préopératoires de TSH binding inhibitory immunoglobuline (TBII) et des anticorps antimicrosomial hemagglutination (MCHA). On a utilisé le test Chi2 en analyse monofactorielle et, par modèle logistique, pour l'analyse multifactorielle. La récidive précoce a été définie par l'existence d'une suppression de la TSH observée pendant la première année après la chirugie et durant au moins 6 mois. Cent six patients (14.67%) ont eu une récidive précoce. Les facteurs significatifs étaient la taille du moignon, le MCHA et 1 TBII. Ces résultats indiquent que TBII et MCHA sont des facteurs de récidive précoce. Chez le patient ayant des taux élevés de TBII et MCHA, il vaut mieux réduire d'avantage la taille du moignon pour éviter les risques de récidive précoce.
Resumen
Un prerrequisito para el tratamiento quirúrgico de la enfermedad de Graves es que pueda ser realizado no sólo con seguridad sino también con una baja incidencia de hipertiroidismo recurrente. La recurrencia temprana es especialmente indeseable. Hemos estudiado 728 pacientes con enfermedad de Graves tratados mediante tiroidectomía subtotal utilizando análisis multivariable con miras a identificar los factores que se relacionan con recurrencia temprana. Los siguientes factores fueron analizados: edad, sexo, duración del tratmiento médico, peso del tejido tiroideo resecado, tamaño del remanente tiroideo, nivel sérico preoperatorio de inmunoglobulina inhibidora de la ligadura de TSH (TBII) y de anticuerpo antimicrosomal de hemaglutinación MCHA). Se definió la “recurrencia temprana” como la supresión de TSH que ocurre en el curso del primer año luego de la cirugía y que se continúa por lo menos por 6 meses. Ciento seis pacientes, 14.6%, presentaron recurrencia temprana. El análisis estadístico demostró que el remanente de tiroides, el MCHA y la TBII fucron los factores de significación. Estos resultados indican que la TBII y el MCHA están relacionados con el fenómeno de la recurrencia temprana del hipertiroidismo y por ello se recomienda, para evitar tal recurrencia, un remanente tiroideo menor en los pacientes con MCHA elevada y/o nivel elevado de TBII.
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Sugino, K., Mimura, T., Ozaki, O. et al. Early recurrence of hyperthyroidism in patients with Graves' disease treated by subtotal thyroidectomy. World J. Surg. 19, 648–652 (1995). https://doi.org/10.1007/BF00294748
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DOI: https://doi.org/10.1007/BF00294748