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Modified subtotal thyroidectomy for Graves' disease: a two-institution study.

In an effort to decrease the large number of patients who develop hypothyroidism after operations for Graves' disease, an identical modification of the conventional subtotal thyroidectomy (CST) was independently designed and tested in a prospective study at two institutions. The modified subtotal thyroidectomy (MST) essentially consists of leaving an accurately measured 5 gm thyroid remnant and an intact inferior thyroid artery on each side of the neck. By use of MST, euthyroidism, as demonstrated by serial clinical and thyroid function tests, has been achieved in 92% of a combined group of 107 patients followed longer than 2 years (average 62.1 months). Postoperative hypothyroidism developed in only two cases (2%), representing a marked improvement over the 40% to 75% rate of hypothyroidism resulting from CST. Recurrent hyperthyroidism occurred in only six cases, a rate of recurrence indistinguishable from that resulting from the more extensive resection required by CST. Enlargment of total remnant size to a total of 10 gm significantly improves long-term postoperative functional results without risking an increase in recurrence. The functional results obtained after MST are superior to those obtained after treatment with radioiodine and justify renewed interest in the surgical treatment of Graves' disease.