A. Gillis1, R. Obiarinze1, C. MCLEOD1, P. ZMIJEWSKI1, J. FAZENDIN1, H. CHEN1, B. Lindeman1 1University Of Alabama at Birmingham, Breast And Endocrine Surgery, Birmingham, Alabama, USA
Introduction: Graves’ disease is the most common cause of hyperthyroidism with 20-30 cases per 100,000 individuals annually in the United States. Symptoms of Graves’ disease are wide ranging and may include heart palpitations, fatigue, tremors, and diarrhea. Graves’ disease is typically treated with either radioactive iodine, antithyroid drugs, or total thyroidectomy. Total thyroidectomy (TT) has been shown to be a safe and effective treatment for Graves’ disease. However, the time course for improvement or resolution of subjective symptoms has not been defined.
Methods: With institutional review board approval, we performed a review of prospectively-gathered survey data of all patients undergoing TT for Graves’ disease at a single institution from 2019-2021. After informed consent was obtained, patients electing to participate (N=79) filled out surveys preoperatively and at post-operative follow-up visits/phone calls. All patients were operated on by one of three high-volume endocrine surgeons. Patient demographics as well as survey results were collected and analyzed using the Kaplan-Meier method and compared by log-rank analysis.
Results:A total of 50 patients completed the survey on postoperative follow-up (response rate 63%). The mean follow-up was 5 months (0.5-14 months). Average age was 38 years (12-80) and 88% of patients were female. The most common preoperative symptoms were fatigue (90%) and heat/cold intolerance (88%). Tremor, diarrhea, and palpitations were the symptoms that resolved most quickly, with a median resolution of 1 week or by the first follow-up visit. Median resolution of symptoms was 3 weeks for exophthalmos, heat/cold intolerance, fatigue, anxiety, and memory deficit. Depression, seen in 32% of patients, took the longest to improve, with a median time to improvement of 10 weeks. There were no significant differences in time to resolution of symptoms by gender or age. Only three patients (6%) had any symptoms remaining at 12 months.
Conclusion:Many Graves’ disease symptoms improve rapidly following TT, with a median time to improvement of less than 1 month. Understanding the typical time course is important for counseling patients and managing expectations pre- and postoperatively.
