Clinical characteristics of a diffuse toxic goiter in men

Abstract

Introduction. Graves disease (GD) managements are varying. More then 40% GD patients undergo surgery in Russia. Materials and Methods. In the Centre 2920 GD patients were operated on. They made 11.7% of 24934 Thyroid (T) surgical cases during 1974-2009. This study includes 357 males (M) and 2527 females (F) observed 2-30 years after Dunhill-Drachinskaya operations (leaving 2-4 g. of some T upper pole) or thyroidectomy. Long-term results of treatment have been evaluated 2-30 years later in 336 (94.1%) males and 119 (99%) females. Statistic analysis of the data was performed using “Statistica” software. Results. Average age made 46.2 ± 2.5 years. M (43.2 ± 1.5) were significantly (p <0.05) younger then F (47.3 ± 1.8). Age of GD beginning was about 39. Duration of diseases of M was much shorter (2.1 ± 0.9) then F (7.2 ± 1.9). Cardiac fibrillation happened in 32.1% of M, 13.7% - in F, exophthalmia - in 44.4% of M, in 24.8% of F (P <0.05). Deterioration of libido and potency has observed in 40.6% and 48.9% of M (39.1 ± 0.4). Plasmapheresis was applied in 9.4% of M, 5.8% - of F. Thyroid has neck location in 55.0% of M, 62.0% - of F. T more often extended behind of sternum and trachea in M. The indication for operations: recurrent and complicated hyperthyroidism (47.0%); compression syndrome (27.0%); allergy (7.0%); oncological risk, pregnancy (19.0%). Postoperative unilateral RLN palsy was found at 0.9%, temporary hypoparathyroidism - at 1.7%. T remnant function was stabilized per the first 12-18 months. In 2-5 years later euthyroid condition observed in 63.4%, postoperative hypothyroidism - at 29.8%, subclinical hypothyroidism - at 5.4%, the relapse of thyrotoxicosis - at 1.36%. Conclusion. Clinical manifestations of M and F GD have essential differences with more aggressive course in M. Relapses of GD are rare after Dunhill-Drachinskaya T resection. Aggressive course of GD in M demands early surgical treatment.