Total Versus Subtotal Thyroidectomy in Graves' Disease At AUH

Not Applicable

• Conditions: Thyroid Goiter
• Interventions: Procedure: subtotal thyroidectomy; Procedure: total thyroidectomy

• Registration Number: NCT04577664
• Lead Sponsor: Assiut University

Brief Summary

The main aim of work is to compare between subtotal and total thyroidectomy intra and postoperatively to identify which technique is better for patient of graves disease

Detailed Description

Graves' disease is an autoimmune disease that affects the thyroid gland\[1\] and it's the most common cause of hyperthyroidism. \[2\] Treatment of Graves' disease includes antithyroid drugs ; radioiodine ; and thyroidectomy . patients with Graves' hyperthyroidism can be treated with any of these treatment options. There is a wide geographic variation in the choice of therapy.\[3\] Medical treatment with antithyroid drugs is often accepted as first-choice modality in Europe, followed by radioiodine in case of recurrence. Although surgery offers the advantage of quick control and low morbidity in experienced hands, it is infrequently recommended as initial treatment. Therapy with radioiodine is the most common treatment in the United States, while antithyroid drugs and/or thyroidectomy are used more often in Europe, Japan, and most of the rest of the world.recent literature shows that the relapse rate was the highest among patients who received antithyroid drugs (40%) as compared to those who received radioiodine (21%) or Surgery (5). \[4\] Two different surgical techniques are used for the treatment of Graves' hyperthyroidism: a total thyroidectomy (TT) in which the entire gland is removed and a subtotal thyroidectomy (STT) , in which most of the gland is removed leaving a small unilateral or bilateral remnant in situ about 4-5 grams. Although thyroidectomy has been broadly considered as a viable alternative theapy for patients with Graves' disease , the resection extent and remnant size of thyroid gland remains controversial.\[6\] Although total thyroidectomy has a lower recurrence rate it has raised a concern that a more radical operation would increase the complications.\[7\] we intend to perform this analysis based on the published literatures of randomized controlled trials to evaluate the specific risks of thyroid surgery including recurrent hyperthyroididm , post-operative bleeding , recurrent laryngeal nerve injury , hypoparathyroidism and opthalmopathy progression.

Study Timeline

• Study First Submitted: 2020-07-28
• Status Verified: 2020-10
• Study First Submitted QC: 2020-10-02
• Last Update Submitted: 2020-10-02
• Study First Posted: 2020-10-08
• Last Update Posted: 2020-10-08
• Study Start: 2020-11
• Primary Completion: 2021-11
• Study Completion: 2021-12

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 60

Inclusion Criteria

• patients diagnosed clinically, biochemically and immunologically with Graves' disease who will undergo thyroidectomy at general surgery department in AUH.

Exclusion Criteria

• 1- previous thyroid or parathyroid surgery.

  • 2- recurrent hyperthyroidism after radioiodine therapy.
  • 3- preoperative recurrent laryngeal nerve palsy.
  • 4- patients unfit for operation.
  • 5- inability to comply with the follow-up protocol.
  • 6- suspicious thyroid nodules.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
ST group	subtotal thyroidectomy	-
TT group	total thyroidectomy	-

Primary Outcome Measures

Name	Time	Method
comparison between total thyroidectomy vs subtotal thyroidectomy in graves' disease	baseline	Prevlance of recurrent hyperthyroidism

Secondary Outcome Measures

Name	Time	Method
comparison between total thyroidectomy vs subtotal thyroidectomy in graves' disease	baseline	Postoperative hypocalcemia and hypoparathyroidism.