Long-term results of conservative and surgical treatment of toxic goiter

Abstract

The study covered 154 patients with different forms of toxic goiter: 143 patients were diagnosed as having Graves' disease (GD) and 11 had thyroid functional autonomy (FA). Among the patients with GD, 111 had received conservative thyrostatic therapy of varying duration; of them 23 patients were subsequently operated on for its recurrence. Furthermore, in 32 patients with GD, operation was undertaken as primary treatment. A permanent remission of GD occurred only in 29.7% of the patients receiving thyrostatic therapy. The risk factors of recurrent GD included young age (under 30 years), a large size of goiter (more than 30 ml), and the absence of a decrease or an increase in the volume of the thyroid during therapy. The presence of endocrine ophthalmopathy and its development after the initiation of therapy did not affect the likelihood of recurrent thyrotoxicosis. The "block-and-replace" scheme (co-adminis- tration of a thyrostatic and L-thyroxine) proved to be preferable to thyrostatic monotherapy (the "block" scheme) in the context of a greater probability of remission after completion of therapy. In the outcome of surgical treatment of toxic goiter (subtotal thyroidec­tomy), hypothyroidism, recurrent thyrotoxicosis, and euthyrosis developed in 77.3, 15.2, and 7.5%) of cases, respectively; in this con­nection it is concluded that permanent hypothyroidism that is achieved virtually by complete thyroid removal (maximally subtotal resection, thyroidectomy) should be considered to be a favorable predictor of surgical treatment for toxic goiter.