Endocrine Abstracts

Introduction

Graves’ disease is an autoimmune thyroid disease manifested by hyperthyroidism, homogeneous goiter and sometimes ophthalmopathy. The frequency of the disease is less than 1% with a female predominance of 5–10/1 male. Its treatment is difficult because of the evolving vagaries of this disease. We report the results of surgery for Graves’ disease through a retrospective study.

Material and methods

100 files of patients operated on for Graves’ disease (MB) either as first-line after preparation for medical treatment (average duration of less than 6 months) in 9 or after failure of medical treatment in 91%.

Results

Average age: between (20–60 years)

Female predominance

Reason for consultation: goiter + signs of hyperthyroidism): 79%

Basedowian ophthalmopathy 69%.

Palpation of the neck: goiter type 2: 74 (firm, elastic, vascular in 70%)

The thyroid hormone balance: TSHus slowed down in all cases (avg: 0.12 U/ml) associated with an increase in peripheral hormones FT3 and/or FT4.

The autoimmunity assessment

Anti TPO Ab: 13% positive, Anti TSHus receptor TSI 20% positive, TG Ab 3% positive

Surgery results

65% of patients (P) underwent a total thyroidectomy.

35% (P): subtotal thyroidectomy

Histology

82% of patients: Typical basal disease

17% (P) Graves’ disease associated with cell variants

• Oncocytic metaplasia

• Functional hyperplasia

1% (P) papillary microcarcinoma + MB.

Conclusion

The management of Graves’ disease requires a precise diagnosis as well as an appropriate treatment. Follow-up depends on the speed of the response and the occurrence of recurrence. The medical treatment for Graves’ disease takes a long time. It imposes physical and economic constraints with a high rate of relapses. If remission does not occur radical treatment is indicated by radioiodine or surgery.