Endocrine Abstracts (2006) 11 P864

Surgery should be considered equally with I131 and thionamide treatment as first line therapy for thyrotoxicosis

T Sathyapalan1, SL Atkin2 & RJA England1

1Hull Royal Infirmary, Hull, East Yorkshire, United Kingdom; 2Hull York Medical School, Hull, East Yorkshire, United Kingdom.

Objectives: To analyse the outcome of 100 consecutive patients treated for thyrotoxicosis by total thyroidectomy, and compare the efficacy of this treatment modality to I131 therapy and thionamide therapy.

Design: Data collected prospectively from a tertiary referral multidisciplinary thyroid clinic on 100 consecutive patients operated on for thyrotoxicosis by one thyroid surgeon. Patient demographics, reasons for selection of surgical treatment, preoperative treatment and postoperative complications were recorded. Histological diagnoses were also recorded. All patient data was anonymised.

Participants: All patients who underwent surgery for thyrotoxicosis through the thyroid clinic between November 2000 and June 2004. Data collection was suspended once 100 sequential patients were included.

Results: 71% of patients underwent surgery out of preference. The haematoma rate was 4%. There were no permanent recurrent laryngeal nerve palsies. The temporary hypocalcaemia rate was 12%, the permanent hypocalcaemia rate was 2%. These complication rates with the 100% cure rate compare very favourably with the other two treatment modalities. In addition four malignant histologies were discovered (three T1 papillary carcinomas and one T4 multicentric papillary carcinoma).

Conclusions: The risks from surgery for thyrotoxicosis are lower then appreciated. A surprising number of patients opt for surgery for definitive treatment of the condition when given the choice suggesting that the choice is not offered sufficiently frequently. A 4% malignancy rate was evident in the series and these cancers would have presented later if the patients had not opted for surgery. Surgery should be considered equally with thionamide therapy and I131 therapy as first line management of thyrotoxicosis.

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