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BMJ. 2007 April 7; 334(7596): 710.
PMCID: PMC1847871
Hyperthyroidism

Total thyroidectomy is best operation for thyrotoxicosis

R James A England, consultant ear, nose, and throat surgeon and Steve Atkin, professor of endocrinology

We were concerned by the statement that subtotal thyroidectomy in experienced hands guarantees patients the longest existence without taking drugs.1 This implies that subtotal thyroidectomy is the operation of choice in thyrotoxicosis. We believe that is not the case, firstly, because the operation of subtotal thyroidectomy is not clearly defined: the amount of thyroid tissue left behind varies from centre to centre. Secondly, there is a small but definite occurrence rate of thyroid cancer in both Graves' disease and toxic multinodular goitre (4% in our series of 100 total thyroidectomies (all pathologies) for thyrotoxicosis2). Thirdly, because there is a notable rate of both postoperative hyperthyroidism and hypothyroidism after subtotal thyroidectomy, each outcome effectively defeats the point of the operation type.3 4

Total thyroidectomy is the only appropriate procedure for the surgical management of thyrotoxicosis in the United Kingdom. It guarantees cure, and, although it also guarantees hypothyroidism, thyroxine replacement treatment is far more predictable as the operation is clearly defined.

Notes

Competing interests: None declared.

References

1. Toft A, Sandeep TC. Radioiodine treatment of hyperthyroidism. BMJ 2007;334:483-4. (10 March.) [PMC free article] [PubMed]
2. England RJA, Kamath MB, Jabreel A, Dunne G, Atkin SL. How we do it: surgery should be considered equally with I131 and thionamide treatment as first line therapy for thyrotoxicosis. Clin Otol 2006;31:160-2.
3. Hedley AJ, Bewsher PD, Jones SJ, Khir AS, Clements P, Matheson NA, et al. Late onset hypothyroidism after subtotal thyroidectomy for hyperthyroidism: implications for long term follow-up. Br J Surg 1983;70:740-3. [PubMed]
4. Lal G, Ituarte P, Kebebew E, Siperstein A, Duh QY, Clark OH. Should total thyroidectomy become the preferred procedure for the surgical management of Graves disease? Thyroid 2005;15:569-74. [PubMed]

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