Total thyroidectomy: is morbidity higher for Graves\u27 disease than nontoxic goiter?

BACKGROUND: Total thyroidectomy for treatment of Graves\u27 disease is controversial and much of the debate centers on the concern for complications. The purpose of this study was to evaluate the morbidity of total thyroidectomy for Graves\u27 disease and determine if it is different than for patients with nontoxic nodular goiter. METHODS: The rates of life threatening neck hematoma, recurrent laryngeal nerve (RLN) injury, transient hypocalcemia, and hypoparathyroidism were determined for consecutive patients with Graves\u27 disease treated with total thyroidectomy from 1996 to 2010. Results were compared with patients who underwent total thyroidectomy for nontoxic nodular goiter during the same period, matched for the weight of the excised thyroid gland. RESULTS: Total thyroidectomy was performed in 111 patients with Graves\u27 disease (group I) and 283 patients with nontoxic nodular goiter (group II). Parathyroid autotransplantation was performed in 31(28%) patients in group I and 98 (35%) patients in group II (P = NS). Comparative analysis of morbidity revealed no significant difference in neck hematoma, 0(0%) (I) versus 3(1%) (II); permanent RLN injury, 0(0%) (I) versus 2(1%) (II); and permanent hypoparathyroidism in 1(1%) (I) versus 1 (0.4%) (II) (P = NS). Transient hypocalcemia was more common in patients with Graves\u27 disease, 80(72%) (I) versus 170 (60%) (II) (P \u3c 0.05), but not when matched for thyroid weight. CONCLUSIONS: Total thyroidectomy can be performed with low morbidity in patients with Graves\u27 disease; only transient hypocalcemia occurred more often than in patients with nodular goiter. Total thyroidectomy should be presented as a therapeutic option for all patients with Graves\u27 disease