ATTUALI ORIENTAMENTI NEL TRATTAMENTO DEL MORBO DI BASEDOW

Between 1973 and 1992 153 patients with Graves' disease were observed at the Surgery and Oncology Institute-Cagliari University. 103 underwent subtotal (70) or total (33) thyroidectomy, while 50(after 1985) were submitted to radioactive-iodine therapy. Surgical indications were failure of antithyroid drug therapy, signs of compression and large size goitre. Until 1988, all patients were submitted to subtotal thyroidectomy with thyroid remnant of about 8 g. From 1988 the choice of total thyroidectomy came out from: similar complications (paralysis of recurrent nerve and hypoparathyroidism), lack of relapse and suppression of risk of occult carcinoma. After subtotal thyroidectomy definitive hypoparathyroidism in 1 patient (1.8%), transitory hypoparathyroidism in 5 (9.4%), clinical hypothyroidism in 17 (31.5%), recidive hyperthyroidism in 3 patients (5.5%) were observed. After total thyroidectomy 1 patient presented definitive paralysis of recurrent nerve (3%), 1 definitive hypoparathyroidism (3%), 8 transitory hypoparathyroidism (24%): small (44 patients) or large goitre (3 patients) or relapse (3 patients) were indications to radioactive-iodine therapy. At median follow-up of 16 months no relapses of hyperthyroidism were observed, while clinical signs of hypothyroidism were present in 33% of patients. Authors stress that, after a first attempt with antithyroid drugs therapy, radioiodine treatment is elective in Graves' disease. Surgery still remains the treatment of choice during pregnancy, in patients with large goitres, signs of compression or in presence of scintigraphic "cold" area.