Recurrent Hyperthyroidism After Thyroidectomy Joel I.
Hamburger,
MD
\s=b\ For 53 patients with toxic recurrent goiter (TRG), the interval between thyroidectomy and recurrent hyperthyroidism ranged from six months to 50 years (average, 12.4 \m=+-\11.9 years). Recurrent hyperthyroidismmay occur in older patients for whom cardiac decompensation may be the initial manifestation. Reports on surgically treated hyperthyroid patients may underestimate the incidence of TRG unless follow-up is extended for many years.
(Arch Surg 111:91-92, 1976)
that recurrent
surgical literature suggests Thehyperthyroidism thyroidectomy—toxic current
after
recur¬
rent goiter (TRG)—is uncommon more than five years af¬ ter operation, and that later recurrences constitute little risk since the patients are likely to appreciate the signifi¬
of the recurrent features of thyrotoxicosis. A re¬ cently encountered patient in whom TRG developed 50 years after thyroidectomy prompted a review of our TRG series to assess the time interval between thyroidectomy and the recurrence of thyrotoxicosis. cance
RESULTS
Table 1 gives the sex and age at the time of recurrence for 63 TRG patients. The sex distribution resembled that for hyperthyroid patients with toxic diffuse goiter. How¬ ever, TRG patients were older: 19% of them were 60 years
Accepted for publication July 9, 1975. From the Northland Thyroid Laboratory, Southfield, Mich. Reprint requests to Northland Thyroid Laboratory, 20905 Greenfield Rd, Suite 300, Southfield, MI 48075 (Dr Hamburger).
old or older, compared to 8.6% of 1,092 patients with toxic diffuse goiter. Table 2 shows the interval between thyroidectomy and recurrent hyperthyroidism. For ten patients, these data were unavailable. Note that 49% of the recurrences oc¬ curred ten or more years after the original operation, and 19% were between 20 and 50 years later. Three patients had thyroidectomy twice. For two, the second operation was within a few months of the initial thyroidectomy. The third patient is briefly described in the next section. Three patients had unsuccessful attempts at controlling recurrent hyperthyroidism with propylthiouracil alone. Radioactive iodine therapy proved effective in all three. REPORT OF A CASE A 68-year-old woman reported having undergone thyroidectomy for thyrotoxicosis in 1927 and again in 1950. She remained in rea¬ sonably good health until 1971 when the development of atrial fibrillation and progressive cardiac decompensation, responding poorly to the usual measures, led to the discovery of recurrent hy¬ perthyroidism. Radioactive iodine therapy, after four weeks'
preparation with propylthiouracil administration, proved success¬ ful.
COMMENT
Recently, most of those who have dealt with TRG have approached the problem from the standpoint of what hap¬ pens to a group of hyperthyroid patients after thyroidec¬ tomy. The duration of follow-up was limited both by pa¬ tient compliance and physician persistence. In seven recent reports, the maximum follow-up was 20 years, and the average less than ten years.
Downloaded From: http://archsurg.jamanetwork.com/ by a Yale University User on 05/15/2015
Table
Table 2.—Time Interval Between Surgery and Recurrent Hyperthyroidism in 43 Patients*
and Sex Distribution in 63 Patients With Toxic Recurrent Goiter
1.—Age
Age, yr 15-19 20-39 40-59 60-81 Total
Males 1 4 3 2 10
Females 1 23 19 10 53
Interval, yr 10-19 20-29 30-39 40-50
27 22 12
Our data differ since we reviewed TRG patients drawn from a surgically treated population whose size is un¬ known. Therefore, we cannot comment on the incidence of TRG. Our data are consistent with those in a recent Brit¬ ish report on 90 TRG patients, 45.5% of whom developed recurrent thyrotoxicosis more than five years after sur¬ gery, and 13.3% fifteen to 28 years after thyroidectomy, as well as in a report from the Mayo Clinic citing three ex¬ amples of TRG that occurred more than 25 years after
thyroidectomy.
>5_17_
Total
63
No. of Patients X12.4
SD ±11.9
16
49%
"Data were not available for ten
y 19%
patients.
CONCLUSIONS
Lifelong follow-up of surgically treated hyperthyroid patients seems prudent if all patients with TRG are to be 1.
detected. 2. In the elderly, cardiac decompensation may appear as the predominant clinical feature of TRG. References will be
Downloaded From: http://archsurg.jamanetwork.com/ by a Yale University User on 05/15/2015
supplied by
the author
on
request.
Hamburger,
MD
\s=b\ For 53 patients with toxic recurrent goiter (TRG), the interval between thyroidectomy and recurrent hyperthyroidism ranged from six months to 50 years (average, 12.4 \m=+-\11.9 years). Recurrent hyperthyroidismmay occur in older patients for whom cardiac decompensation may be the initial manifestation. Reports on surgically treated hyperthyroid patients may underestimate the incidence of TRG unless follow-up is extended for many years.
(Arch Surg 111:91-92, 1976)
that recurrent
surgical literature suggests Thehyperthyroidism thyroidectomy—toxic current
after
recur¬
rent goiter (TRG)—is uncommon more than five years af¬ ter operation, and that later recurrences constitute little risk since the patients are likely to appreciate the signifi¬
of the recurrent features of thyrotoxicosis. A re¬ cently encountered patient in whom TRG developed 50 years after thyroidectomy prompted a review of our TRG series to assess the time interval between thyroidectomy and the recurrence of thyrotoxicosis. cance
RESULTS
Table 1 gives the sex and age at the time of recurrence for 63 TRG patients. The sex distribution resembled that for hyperthyroid patients with toxic diffuse goiter. How¬ ever, TRG patients were older: 19% of them were 60 years
Accepted for publication July 9, 1975. From the Northland Thyroid Laboratory, Southfield, Mich. Reprint requests to Northland Thyroid Laboratory, 20905 Greenfield Rd, Suite 300, Southfield, MI 48075 (Dr Hamburger).
old or older, compared to 8.6% of 1,092 patients with toxic diffuse goiter. Table 2 shows the interval between thyroidectomy and recurrent hyperthyroidism. For ten patients, these data were unavailable. Note that 49% of the recurrences oc¬ curred ten or more years after the original operation, and 19% were between 20 and 50 years later. Three patients had thyroidectomy twice. For two, the second operation was within a few months of the initial thyroidectomy. The third patient is briefly described in the next section. Three patients had unsuccessful attempts at controlling recurrent hyperthyroidism with propylthiouracil alone. Radioactive iodine therapy proved effective in all three. REPORT OF A CASE A 68-year-old woman reported having undergone thyroidectomy for thyrotoxicosis in 1927 and again in 1950. She remained in rea¬ sonably good health until 1971 when the development of atrial fibrillation and progressive cardiac decompensation, responding poorly to the usual measures, led to the discovery of recurrent hy¬ perthyroidism. Radioactive iodine therapy, after four weeks'
preparation with propylthiouracil administration, proved success¬ ful.
COMMENT
Recently, most of those who have dealt with TRG have approached the problem from the standpoint of what hap¬ pens to a group of hyperthyroid patients after thyroidec¬ tomy. The duration of follow-up was limited both by pa¬ tient compliance and physician persistence. In seven recent reports, the maximum follow-up was 20 years, and the average less than ten years.
Downloaded From: http://archsurg.jamanetwork.com/ by a Yale University User on 05/15/2015
Table
Table 2.—Time Interval Between Surgery and Recurrent Hyperthyroidism in 43 Patients*
and Sex Distribution in 63 Patients With Toxic Recurrent Goiter
1.—Age
Age, yr 15-19 20-39 40-59 60-81 Total
Males 1 4 3 2 10
Females 1 23 19 10 53
Interval, yr 10-19 20-29 30-39 40-50
27 22 12
Our data differ since we reviewed TRG patients drawn from a surgically treated population whose size is un¬ known. Therefore, we cannot comment on the incidence of TRG. Our data are consistent with those in a recent Brit¬ ish report on 90 TRG patients, 45.5% of whom developed recurrent thyrotoxicosis more than five years after sur¬ gery, and 13.3% fifteen to 28 years after thyroidectomy, as well as in a report from the Mayo Clinic citing three ex¬ amples of TRG that occurred more than 25 years after
thyroidectomy.
>5_17_
Total
63
No. of Patients X12.4
SD ±11.9
16
49%
"Data were not available for ten
y 19%
patients.
CONCLUSIONS
Lifelong follow-up of surgically treated hyperthyroid patients seems prudent if all patients with TRG are to be 1.
detected. 2. In the elderly, cardiac decompensation may appear as the predominant clinical feature of TRG. References will be
Downloaded From: http://archsurg.jamanetwork.com/ by a Yale University User on 05/15/2015
supplied by
the author
on
request.
