La terapia chirurgica del morbo di Basedow. Tiroidectomia totale o subtotale a confronto

Abstract

The surgical treatment of Basedow's disease is the most rapid and effective therapeutic approach to obtain the long-term remission of disease. Controversy persists regarding the choice of total or subtotal thyroidectomy. The authors report their experience in 38 cases of Basedow's disease undergoing surgery, of which 20 were treated with total thyroidectomy and 18 with subtotal thyroidectomy. No hemorrhages, wound infections, recurrent lesions, or definitive hypoparathyroidism were observed in the two groups of patients. Those patients undergoing subtotal thyroidectomy reported a 44.5% incidence of hypothyroidism. In particular, hypothyroidism was clinically manifest in 16.7% of cases and subclinical in 27.8%, namely only revealed by the assay of thyroid hormones. Relapse of hyperthyroidism was also reported in 16.7% of the cases treated by subtotal thyroidectomy. On the basis of these results and owing to the high incidence of hypothyroidism and the relatively high percentage of recurrent hyperthyroidism after subtotal thyroidectomy, the authors conclude that total thyroidectomy may be considered the surgical treatment of choice in Basedow's disease in that there were no major complications following this type of surgery compared to subtotal thyroidectomy. Moreover, total thyroidectomy eliminates the risk of recurrent hyperthyroidism and therefore the need to re-operate, and also ensures the removal of possible foci of occult carcinoma reported in 5-10% of cases.