Abstract

ABSTRACT

Background: Total thyroidectomy is an effective treatment for Graves' disease, especially in patients with large goiters.

Objective: To evaluate the outcomes of total thyroidectomy in patients with Graves’ disease associated with large goiters and to report several technical experiences in surgical management.

Materials and Methods: A prospective descriptive study was conducted on 18 patients with Graves’ disease presenting with grade III large goiter according to the WHO classification, who underwent total thyroidectomy at Hue Central Hospital from January 2025 to March 2026.

Results: The mean age of the study group was 38.6 years, with a male-to-female ratio of 1:17. Medical treatment failure was observed in 94.4% of cases, and 88.9% of patients had Graves’ ophthalmopathy. The mean thyroid volume was 80.5 mL. The mean operative time was 70.6 minutes, and the average intraoperative blood loss was 65 mL. Temporary hypocalcemia was recorded in 55.6% of cases, temporary tetany occurred in 33.3%, and temporary hoarseness was observed in 22.2% of patients.

Conclusion: Total thyroidectomy is a definitive and effective treatment for Graves’ disease associated with grade III large goiters. Although the incidence of temporary postoperative complications (hypocalcemia, hoarseness) remains relatively high due to the complex nature of large goiters, the rate of permanent complications is reassuringly low. Technically, the lateral approach to the posterior branch of the superior thyroid artery has proven feasible, facilitating optimal surgical exposure. However, further well-controlled studies with larger cohorts are warranted to substantiate its potential benefits in minimizing blood loss and shortening operative time.

Keywords: Graves' disease, Total thyroidectomy, Large goiter