The Experts below are selected from a list of 1449 Experts worldwide ranked by ideXlab platform
Kiminori Sugino - One of the best experts on this subject based on the ideXlab platform.
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change of surgical strategy for graves disease from Subtotal Thyroidectomy to total Thyroidectomy a single institutional experience
Endocrine Journal, 2019Co-Authors: Kiminori Sugino, Mitsuji Nagahama, Wataru Kitagawa, Keiko Ohkuwa, Takashi Uruno, Akifumi Suzuki, Kenichi Matsuzu, Chisato Tomoda, Kiyomi Y Hames, Junko AkaishiAbstract:The extent of Thyroidectomy in Graves' disease remains controversial. In our institution, long-term euthyroidism without thyroxin replacement therapy has been the aim, and it has long been the standard surgical procedure used to treat Graves' disease in many institutions, including our hospital. Based our several clinical studies, it was concluded that Subtotal Thyroidectomy is not suitable as a standard surgical procedure for the treatment of Graves' disease. In 2009, the surgical strategy for Graves' disease was changed from Subtotal Thyroidectomy to total Thyroidectomy in our hospital. In this study, how surgical complications have changed after this modification was examined. The subjects were 1,476 patients with Graves' disease treated by Thyroidectomy between 2006 and 2014. There were 1,119 females and 357 males with a median age of 39 years. A total of 660 patients underwent bilateral Subtotal Thyroidectomy (ST group), and 816 patients underwent total Thyroidectomy (TT group). Both transient hypocalcemia and prolonged hypocalcemia were observed significantly more frequently in the TT group than in the ST group (p < 0.001). Total Thyroidectomy was identified as risk factors for prolonged hypocalcemia on multivariate analysis. In conclusion, total Thyroidectomy is a reliable and effective therapy for controlling hyperthyroidism in terms of controlling of hyperthyroidism. However, it should be noted that total Thyroidectomy resulted in increased rate of prolonged hypocalcemia. Surgeons should try to reduce the surgical complication rate as much as possible.
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changes in the thyroid function of graves disease patients treated by Subtotal Thyroidectomy
Endocrine Journal, 2012Co-Authors: Kiminori Sugino, Koichi Ito, Mitsuji Nagahama, Wataru Kitagawa, Hiroshi Shibuya, Keiko Ohkuwa, Yukiko Yano, Takashi Uruno, Junko Akaishi, Akifumi SuzukiAbstract:The extent of Thyroidectomy in Graves' disease is still a matter of controversy. Subtotal Thyroidectomy has been used as the standard surgical procedure for Graves' disease in Japan, but high hyperthyroidism relapse rates have been reported. We retrospectively studied serial changes in the thyroid function Graves' disease patients after they had been treated by Subtotal Thyroidectomy and assessed whether Subtotal Thyroidectomy should be recommended as the standard surgical procedure for the treatment of Graves' disease. The subjects were 478 Graves' disease patients who underwent Subtotal Thyroidectomy at our institution between 1994 and 1997 and were followed up on a regular basis, and their thyroid function 2-3 years after surgery (the early period) and 8-10 years after surgery (the late period) was evaluated and compared. The evaluations in the late period showed that 57% of the euthyroid patients in the early period remained euthyroid, 30% had developed a relapse of hyperthyroidism, and 13 % had become hypothyroid. Approximately 80% of the patients who were overtly hyperthyroid or overtly hypothyroid in the early period remained so in the late period. During the entire periods 47 patients had subclinical hyperthyroidism and were followed up without any postoperative medication. Twenty (42.6%) of them developed overt hyperthyroidism, 11 (23.4%) experienced a spontaneous remission, and 16 (34%) continued to be subclinically hyperthyroid. Because thyroid function after Subtotal Thyroidectomy is unstable and reduces quality of life, Subtotal Thyroidectomy is concluded not to be suitable as a standard surgical procedure for the treatment of Graves' disease.
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postoperative changes in thyrotropin binding inhibitory immunoglobulin level in patients with graves disease is Subtotal Thyroidectomy a suitable therapeutic option for patients of childbearing age with graves disease
World Journal of Surgery, 1999Co-Authors: Kiminori Sugino, Takashi Mimura, Kunihiko Ito, O Ozaki, Hiroyuki Iwasaki, Nobuyuki WadaAbstract:Thyroid-stimulating hormone (TSH)-binding inhibitory immunoglobulin (TBII) is thought to be one of the essential causes of Graves' disease, and most cases of neonatal hyperthyroidism can be explained by transplacental passage of TBII. Because surgery is often indicated for patients of childbearing age, it is important to elucidate how surgery reduces TBII levels. Between 1988 and 1991 a total of 946 female patients with Graves' disease underwent Subtotal Thyroidectomy. Follow-up examination was undertaken at 1, 2, 3, and 4 to 5 years after surgery. At 4 to 5 years after surgery, 76.8% of patients without recurrent overt hyperthyroidism had TBII 60%, and the number of such patients decreased annually. In most of the patients, immunologic remission was obtained by Subtotal Thyroidectomy except for their having recurrent hyperthyroidism. To acquire immunologic remission, hormonal remission, at least, would be necessary. Because no definite factor other than the size of the thyroid remnant related to postoperative thyroid function was elucidated, near-total Thyroidectomy rather than Subtotal Thyroidectomy is expected to be induced not only hormonal remission but also immunologic remission. It should be noted that a few patients achieved hormonal remission but not immunologic remission.
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effect of Subtotal Thyroidectomy on natural history of ophthalmopathy in graves disease
World Journal of Surgery, 1998Co-Authors: Yoshifumi Abe, Kiminori Sugino, Haruhiro Sato, Masako Noguchi, Takashi Mimura, Osamu Ozaki, Horoshi Yoshimura, Kunihiko ItoAbstract:p < 0.05). In patients treated by Subtotal Thyroidectomy, ophthalmopathy did not change in 77.8%; it progressed in 5.6% and was alleviated in 16.7%. In patients treated with radioactive iodine, the ophthalmopathy did not change in 86.6%, progressed in 10.4%, and was alleviated in 3.0%. These findings indicate that surgery can be a better treatment than radioactive iodine for Graves’ patients with ophthalmopathy.
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factors affecting thyroid function after Subtotal Thyroidectomy for graves disease case control study by remnant weight matched pair analysis
Thyroid, 1997Co-Authors: Osamu Ozaki, Kiminori Sugino, Takashi Mimura, Kunihiko Ito, Koichi ItoAbstract:In order to determine whether there are any predictive factors, other than the amount of remnant thyroid tissue, for subsequent thyroid function after Subtotal Thyroidectomy for Graves' disease, thyroid function was assessed in 329 patients 3 years after surgery, and a case control study was carried out in euthyroid, hyperthyroid, and hypothyroid groups by remnant-weight matched-pair analysis. Factors that affected thyroid function 3 years after surgery were thyroid gland infiltration by lymphocytes and the thyrotropin binding inhibiting immunoglobulin (TBII) value in the hyperthyroid and euthyroid groups, and the free triiodothyronine (FT3) value at the time of surgery and lymph follicle formation in the thyroid gland in the hypothyroid and euthyroid groups. It is concluded that no single factor studied at surgery, other than the amount of remnant tissue, can predict thyroid function after Subtotal Thyroidectomy for Graves' disease.
Kunihiko Ito - One of the best experts on this subject based on the ideXlab platform.
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postoperative changes in thyrotropin binding inhibitory immunoglobulin level in patients with graves disease is Subtotal Thyroidectomy a suitable therapeutic option for patients of childbearing age with graves disease
World Journal of Surgery, 1999Co-Authors: Kiminori Sugino, Takashi Mimura, Kunihiko Ito, O Ozaki, Hiroyuki Iwasaki, Nobuyuki WadaAbstract:Thyroid-stimulating hormone (TSH)-binding inhibitory immunoglobulin (TBII) is thought to be one of the essential causes of Graves' disease, and most cases of neonatal hyperthyroidism can be explained by transplacental passage of TBII. Because surgery is often indicated for patients of childbearing age, it is important to elucidate how surgery reduces TBII levels. Between 1988 and 1991 a total of 946 female patients with Graves' disease underwent Subtotal Thyroidectomy. Follow-up examination was undertaken at 1, 2, 3, and 4 to 5 years after surgery. At 4 to 5 years after surgery, 76.8% of patients without recurrent overt hyperthyroidism had TBII 60%, and the number of such patients decreased annually. In most of the patients, immunologic remission was obtained by Subtotal Thyroidectomy except for their having recurrent hyperthyroidism. To acquire immunologic remission, hormonal remission, at least, would be necessary. Because no definite factor other than the size of the thyroid remnant related to postoperative thyroid function was elucidated, near-total Thyroidectomy rather than Subtotal Thyroidectomy is expected to be induced not only hormonal remission but also immunologic remission. It should be noted that a few patients achieved hormonal remission but not immunologic remission.
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effect of Subtotal Thyroidectomy on natural history of ophthalmopathy in graves disease
World Journal of Surgery, 1998Co-Authors: Yoshifumi Abe, Kiminori Sugino, Haruhiro Sato, Masako Noguchi, Takashi Mimura, Osamu Ozaki, Horoshi Yoshimura, Kunihiko ItoAbstract:p < 0.05). In patients treated by Subtotal Thyroidectomy, ophthalmopathy did not change in 77.8%; it progressed in 5.6% and was alleviated in 16.7%. In patients treated with radioactive iodine, the ophthalmopathy did not change in 86.6%, progressed in 10.4%, and was alleviated in 3.0%. These findings indicate that surgery can be a better treatment than radioactive iodine for Graves’ patients with ophthalmopathy.
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factors affecting thyroid function after Subtotal Thyroidectomy for graves disease case control study by remnant weight matched pair analysis
Thyroid, 1997Co-Authors: Osamu Ozaki, Kiminori Sugino, Takashi Mimura, Kunihiko Ito, Koichi ItoAbstract:In order to determine whether there are any predictive factors, other than the amount of remnant thyroid tissue, for subsequent thyroid function after Subtotal Thyroidectomy for Graves' disease, thyroid function was assessed in 329 patients 3 years after surgery, and a case control study was carried out in euthyroid, hyperthyroid, and hypothyroid groups by remnant-weight matched-pair analysis. Factors that affected thyroid function 3 years after surgery were thyroid gland infiltration by lymphocytes and the thyrotropin binding inhibiting immunoglobulin (TBII) value in the hyperthyroid and euthyroid groups, and the free triiodothyronine (FT3) value at the time of surgery and lymph follicle formation in the thyroid gland in the hypothyroid and euthyroid groups. It is concluded that no single factor studied at surgery, other than the amount of remnant tissue, can predict thyroid function after Subtotal Thyroidectomy for Graves' disease.
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early recurrence of hyperthyroidism in patients with graves disease treated by Subtotal Thyroidectomy
World Journal of Surgery, 1995Co-Authors: Kiminori Sugino, Takashi Mimura, Osamu Ozaki, Hiroyuki Iwasaki, Nobuyuki Wada, Yoshio Kure, Akihiko Matsumoto, Kunihiko ItoAbstract:Prerequistes for surgical treatment of Graves' disease are that it can be done safely and that it is associated with a low incidence of recurrent hyperthyroidism. Early recurrence is especially undesirable. We studied 728 patients with Graves' disease treated by Subtotal Thyroidectomy using multivariate analysis in order to determine the factors related to early recurrence. The following factors were analyzed: age, sex, duration of medical treatment, weight of resected thyroid tissue, thyroid remnant size, preoperative level of thyroid-stimulating hormone (TSH) binding inhibitory immunoglobulin (TBII), and antimicrosomal hemagglutination antibody (MCHA). “Early recurrence” was defined as TSH suppression observed within the first year after surgery and continuing for at least 6 months. A total of 106 patients (14.6%) had early recurrence. Statistical analyses were performed by the chi-square test for univariate analysis and a logistic model for multivariate analysis. Significant factors were thyroid remnant size, MCHA, and TBII. These results indicated that TBII and MCHA are related to early recurrence of hyperthyroidism, and smaller remnant size is recommended for patients with a high MCHA titer or a high TBII level (or both) in order to avoid early recurrence.
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management of recurrent hyperthyroidism in patients with graves disease treated by Subtotal Thyroidectomy
Journal of Endocrinological Investigation, 1995Co-Authors: Kiminori Sugino, Takashi Mimura, O Ozaki, Hiroyuki Iwasaki, Nobuyuki Wada, Akihiko Matsumoto, Kunihiko ItoAbstract:If the aim of surgical treatment for Graves' disease is not permanent hypothyroidism, it is difficult to avoid recurrent hyperthyroidism completely. The management of recurrent hyperthyroidism, however, is neither easy nor obvious. Improvement in the sensitivity of TSH assay has allowed the diagnosis of latent hyperthyroidism. Little is known about the clinical course of latent hyperthyroidism. We studied the management and outcome of recurrent hyperthyroidism in patients with Graves' disease treated by Subtotal Thyroidectomy. Between January 1988 and August 1991, 1115 patients with Graves' disease were treated by surgery. Postoperative thyroid function was evaluated by free T3, free T4 and TSH measurements. One hundred seventy-five patients with suppressed TSH secretion for at least 6 months were categorized as having recurrent hyperthyroidism. Eighty patients (45.1%) also had elevated thyroid hormone levels, (group 1). The remaining 95 patients (54.9%) had normal thyroid hormone levels with suppressed TSH values (group 2). In group 1, 58 patients were treated with antithyroid drug (ATD), 12 with iodine and 10 with radioiodine (RI). Remission of Graves' disease was obtained in 22 patients (11 by ATD, 1 by iodine and 10 by Ri). On the other hand, patients in group 2 were followed up without medication, and spontaneous remission was observed in 21 of theln (22.1%). It was difficult to induce remission of overt recurrent Graves' disease by ATD or iodine. In contrast spontaneous remission could be obtained in some patients with postoperative latent hyperthyroidism.
Takashi Mimura - One of the best experts on this subject based on the ideXlab platform.
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postoperative changes in thyrotropin binding inhibitory immunoglobulin level in patients with graves disease is Subtotal Thyroidectomy a suitable therapeutic option for patients of childbearing age with graves disease
World Journal of Surgery, 1999Co-Authors: Kiminori Sugino, Takashi Mimura, Kunihiko Ito, O Ozaki, Hiroyuki Iwasaki, Nobuyuki WadaAbstract:Thyroid-stimulating hormone (TSH)-binding inhibitory immunoglobulin (TBII) is thought to be one of the essential causes of Graves' disease, and most cases of neonatal hyperthyroidism can be explained by transplacental passage of TBII. Because surgery is often indicated for patients of childbearing age, it is important to elucidate how surgery reduces TBII levels. Between 1988 and 1991 a total of 946 female patients with Graves' disease underwent Subtotal Thyroidectomy. Follow-up examination was undertaken at 1, 2, 3, and 4 to 5 years after surgery. At 4 to 5 years after surgery, 76.8% of patients without recurrent overt hyperthyroidism had TBII 60%, and the number of such patients decreased annually. In most of the patients, immunologic remission was obtained by Subtotal Thyroidectomy except for their having recurrent hyperthyroidism. To acquire immunologic remission, hormonal remission, at least, would be necessary. Because no definite factor other than the size of the thyroid remnant related to postoperative thyroid function was elucidated, near-total Thyroidectomy rather than Subtotal Thyroidectomy is expected to be induced not only hormonal remission but also immunologic remission. It should be noted that a few patients achieved hormonal remission but not immunologic remission.
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effect of Subtotal Thyroidectomy on natural history of ophthalmopathy in graves disease
World Journal of Surgery, 1998Co-Authors: Yoshifumi Abe, Kiminori Sugino, Haruhiro Sato, Masako Noguchi, Takashi Mimura, Osamu Ozaki, Horoshi Yoshimura, Kunihiko ItoAbstract:p < 0.05). In patients treated by Subtotal Thyroidectomy, ophthalmopathy did not change in 77.8%; it progressed in 5.6% and was alleviated in 16.7%. In patients treated with radioactive iodine, the ophthalmopathy did not change in 86.6%, progressed in 10.4%, and was alleviated in 3.0%. These findings indicate that surgery can be a better treatment than radioactive iodine for Graves’ patients with ophthalmopathy.
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factors affecting thyroid function after Subtotal Thyroidectomy for graves disease case control study by remnant weight matched pair analysis
Thyroid, 1997Co-Authors: Osamu Ozaki, Kiminori Sugino, Takashi Mimura, Kunihiko Ito, Koichi ItoAbstract:In order to determine whether there are any predictive factors, other than the amount of remnant thyroid tissue, for subsequent thyroid function after Subtotal Thyroidectomy for Graves' disease, thyroid function was assessed in 329 patients 3 years after surgery, and a case control study was carried out in euthyroid, hyperthyroid, and hypothyroid groups by remnant-weight matched-pair analysis. Factors that affected thyroid function 3 years after surgery were thyroid gland infiltration by lymphocytes and the thyrotropin binding inhibiting immunoglobulin (TBII) value in the hyperthyroid and euthyroid groups, and the free triiodothyronine (FT3) value at the time of surgery and lymph follicle formation in the thyroid gland in the hypothyroid and euthyroid groups. It is concluded that no single factor studied at surgery, other than the amount of remnant tissue, can predict thyroid function after Subtotal Thyroidectomy for Graves' disease.
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preoperative change of thyroid stimulating hormone receptor antibody level possible marker for predicting recurrent hyperthyroidism in patients with graves disease after Subtotal Thyroidectomy
World Journal of Surgery, 1996Co-Authors: Kiminori Sugino, Takashi Mimura, Osamu Ozaki, Hiroyuki Iwasaki, Nobuyuki Wada, Akihiko MatsumotoAbstract:: To make the surgical treatment for Graves' disease more ideal, it is important to elucidate factors related to postoperative thyroid dysfunction in addition to thyroid remnant. Because TSH receptor antibody (TRAb) is thought to be one of the essential causes of Graves' disease, we investigated whether preoperative changes in serum TRAb levels are related to postoperative recurrent hyperthyroidism. Between 1987 and 1992 a total of 1520 patients with Graves' disease were treated by Subtotal Thyroidectomy. Of these patients 335 visited Ito Hospital with no history of drug treatment of their disease and were treated surgically after several courses of antithyroid drug (ATD) therapy. There were 68 males and 267 females with a mean age of 25.8 years. The mean follow-up period was 48 months (range 12-84 months). Factors analyzed by univariate and multivariate analysis were as follows: age, sex, duration of ATD treatment, weight of resected thyroid, weight of thyroid remnant, preoperative titer of MCHA, TRAb at the time of initial examination (TRAb1), TRAb at the time of surgery (TRAb2), and DeltaTRAb, the difference between TRAb1 and TRAb2 (DeltaTRAb = TRAb1 - TRAb2). The chi-square test was used for univariate analysis and a logistic model for multivariate analysis. Of this group, 119 patients were euthyroid (35.5%), 50 were hyperthyroid (14.9%), and 166 were hypothyroid (49.3%). Significant factors related to recurrent hyperthyroidism were weight of thyroid remnant and DeltaTRAb in both univariate and multivariate analyses. DeltaTRAb is a possible new marker for predicting postoperative recurrent hyperthyroidism. If the preoperative TRAb level is not improved by ATDs in patients with Graves' disease, the thyroid remnant should be made smaller.
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early recurrence of hyperthyroidism in patients with graves disease treated by Subtotal Thyroidectomy
World Journal of Surgery, 1995Co-Authors: Kiminori Sugino, Takashi Mimura, Osamu Ozaki, Hiroyuki Iwasaki, Nobuyuki Wada, Yoshio Kure, Akihiko Matsumoto, Kunihiko ItoAbstract:Prerequistes for surgical treatment of Graves' disease are that it can be done safely and that it is associated with a low incidence of recurrent hyperthyroidism. Early recurrence is especially undesirable. We studied 728 patients with Graves' disease treated by Subtotal Thyroidectomy using multivariate analysis in order to determine the factors related to early recurrence. The following factors were analyzed: age, sex, duration of medical treatment, weight of resected thyroid tissue, thyroid remnant size, preoperative level of thyroid-stimulating hormone (TSH) binding inhibitory immunoglobulin (TBII), and antimicrosomal hemagglutination antibody (MCHA). “Early recurrence” was defined as TSH suppression observed within the first year after surgery and continuing for at least 6 months. A total of 106 patients (14.6%) had early recurrence. Statistical analyses were performed by the chi-square test for univariate analysis and a logistic model for multivariate analysis. Significant factors were thyroid remnant size, MCHA, and TBII. These results indicated that TBII and MCHA are related to early recurrence of hyperthyroidism, and smaller remnant size is recommended for patients with a high MCHA titer or a high TBII level (or both) in order to avoid early recurrence.
Nobuyuki Wada - One of the best experts on this subject based on the ideXlab platform.
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postoperative changes in thyrotropin binding inhibitory immunoglobulin level in patients with graves disease is Subtotal Thyroidectomy a suitable therapeutic option for patients of childbearing age with graves disease
World Journal of Surgery, 1999Co-Authors: Kiminori Sugino, Takashi Mimura, Kunihiko Ito, O Ozaki, Hiroyuki Iwasaki, Nobuyuki WadaAbstract:Thyroid-stimulating hormone (TSH)-binding inhibitory immunoglobulin (TBII) is thought to be one of the essential causes of Graves' disease, and most cases of neonatal hyperthyroidism can be explained by transplacental passage of TBII. Because surgery is often indicated for patients of childbearing age, it is important to elucidate how surgery reduces TBII levels. Between 1988 and 1991 a total of 946 female patients with Graves' disease underwent Subtotal Thyroidectomy. Follow-up examination was undertaken at 1, 2, 3, and 4 to 5 years after surgery. At 4 to 5 years after surgery, 76.8% of patients without recurrent overt hyperthyroidism had TBII 60%, and the number of such patients decreased annually. In most of the patients, immunologic remission was obtained by Subtotal Thyroidectomy except for their having recurrent hyperthyroidism. To acquire immunologic remission, hormonal remission, at least, would be necessary. Because no definite factor other than the size of the thyroid remnant related to postoperative thyroid function was elucidated, near-total Thyroidectomy rather than Subtotal Thyroidectomy is expected to be induced not only hormonal remission but also immunologic remission. It should be noted that a few patients achieved hormonal remission but not immunologic remission.
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preoperative change of thyroid stimulating hormone receptor antibody level possible marker for predicting recurrent hyperthyroidism in patients with graves disease after Subtotal Thyroidectomy
World Journal of Surgery, 1996Co-Authors: Kiminori Sugino, Takashi Mimura, Osamu Ozaki, Hiroyuki Iwasaki, Nobuyuki Wada, Akihiko MatsumotoAbstract:: To make the surgical treatment for Graves' disease more ideal, it is important to elucidate factors related to postoperative thyroid dysfunction in addition to thyroid remnant. Because TSH receptor antibody (TRAb) is thought to be one of the essential causes of Graves' disease, we investigated whether preoperative changes in serum TRAb levels are related to postoperative recurrent hyperthyroidism. Between 1987 and 1992 a total of 1520 patients with Graves' disease were treated by Subtotal Thyroidectomy. Of these patients 335 visited Ito Hospital with no history of drug treatment of their disease and were treated surgically after several courses of antithyroid drug (ATD) therapy. There were 68 males and 267 females with a mean age of 25.8 years. The mean follow-up period was 48 months (range 12-84 months). Factors analyzed by univariate and multivariate analysis were as follows: age, sex, duration of ATD treatment, weight of resected thyroid, weight of thyroid remnant, preoperative titer of MCHA, TRAb at the time of initial examination (TRAb1), TRAb at the time of surgery (TRAb2), and DeltaTRAb, the difference between TRAb1 and TRAb2 (DeltaTRAb = TRAb1 - TRAb2). The chi-square test was used for univariate analysis and a logistic model for multivariate analysis. Of this group, 119 patients were euthyroid (35.5%), 50 were hyperthyroid (14.9%), and 166 were hypothyroid (49.3%). Significant factors related to recurrent hyperthyroidism were weight of thyroid remnant and DeltaTRAb in both univariate and multivariate analyses. DeltaTRAb is a possible new marker for predicting postoperative recurrent hyperthyroidism. If the preoperative TRAb level is not improved by ATDs in patients with Graves' disease, the thyroid remnant should be made smaller.
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early recurrence of hyperthyroidism in patients with graves disease treated by Subtotal Thyroidectomy
World Journal of Surgery, 1995Co-Authors: Kiminori Sugino, Takashi Mimura, Osamu Ozaki, Hiroyuki Iwasaki, Nobuyuki Wada, Yoshio Kure, Akihiko Matsumoto, Kunihiko ItoAbstract:Prerequistes for surgical treatment of Graves' disease are that it can be done safely and that it is associated with a low incidence of recurrent hyperthyroidism. Early recurrence is especially undesirable. We studied 728 patients with Graves' disease treated by Subtotal Thyroidectomy using multivariate analysis in order to determine the factors related to early recurrence. The following factors were analyzed: age, sex, duration of medical treatment, weight of resected thyroid tissue, thyroid remnant size, preoperative level of thyroid-stimulating hormone (TSH) binding inhibitory immunoglobulin (TBII), and antimicrosomal hemagglutination antibody (MCHA). “Early recurrence” was defined as TSH suppression observed within the first year after surgery and continuing for at least 6 months. A total of 106 patients (14.6%) had early recurrence. Statistical analyses were performed by the chi-square test for univariate analysis and a logistic model for multivariate analysis. Significant factors were thyroid remnant size, MCHA, and TBII. These results indicated that TBII and MCHA are related to early recurrence of hyperthyroidism, and smaller remnant size is recommended for patients with a high MCHA titer or a high TBII level (or both) in order to avoid early recurrence.
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management of recurrent hyperthyroidism in patients with graves disease treated by Subtotal Thyroidectomy
Journal of Endocrinological Investigation, 1995Co-Authors: Kiminori Sugino, Takashi Mimura, O Ozaki, Hiroyuki Iwasaki, Nobuyuki Wada, Akihiko Matsumoto, Kunihiko ItoAbstract:If the aim of surgical treatment for Graves' disease is not permanent hypothyroidism, it is difficult to avoid recurrent hyperthyroidism completely. The management of recurrent hyperthyroidism, however, is neither easy nor obvious. Improvement in the sensitivity of TSH assay has allowed the diagnosis of latent hyperthyroidism. Little is known about the clinical course of latent hyperthyroidism. We studied the management and outcome of recurrent hyperthyroidism in patients with Graves' disease treated by Subtotal Thyroidectomy. Between January 1988 and August 1991, 1115 patients with Graves' disease were treated by surgery. Postoperative thyroid function was evaluated by free T3, free T4 and TSH measurements. One hundred seventy-five patients with suppressed TSH secretion for at least 6 months were categorized as having recurrent hyperthyroidism. Eighty patients (45.1%) also had elevated thyroid hormone levels, (group 1). The remaining 95 patients (54.9%) had normal thyroid hormone levels with suppressed TSH values (group 2). In group 1, 58 patients were treated with antithyroid drug (ATD), 12 with iodine and 10 with radioiodine (RI). Remission of Graves' disease was obtained in 22 patients (11 by ATD, 1 by iodine and 10 by Ri). On the other hand, patients in group 2 were followed up without medication, and spontaneous remission was observed in 21 of theln (22.1%). It was difficult to induce remission of overt recurrent Graves' disease by ATD or iodine. In contrast spontaneous remission could be obtained in some patients with postoperative latent hyperthyroidism.
Hiroyuki Iwasaki - One of the best experts on this subject based on the ideXlab platform.
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postoperative changes in thyrotropin binding inhibitory immunoglobulin level in patients with graves disease is Subtotal Thyroidectomy a suitable therapeutic option for patients of childbearing age with graves disease
World Journal of Surgery, 1999Co-Authors: Kiminori Sugino, Takashi Mimura, Kunihiko Ito, O Ozaki, Hiroyuki Iwasaki, Nobuyuki WadaAbstract:Thyroid-stimulating hormone (TSH)-binding inhibitory immunoglobulin (TBII) is thought to be one of the essential causes of Graves' disease, and most cases of neonatal hyperthyroidism can be explained by transplacental passage of TBII. Because surgery is often indicated for patients of childbearing age, it is important to elucidate how surgery reduces TBII levels. Between 1988 and 1991 a total of 946 female patients with Graves' disease underwent Subtotal Thyroidectomy. Follow-up examination was undertaken at 1, 2, 3, and 4 to 5 years after surgery. At 4 to 5 years after surgery, 76.8% of patients without recurrent overt hyperthyroidism had TBII 60%, and the number of such patients decreased annually. In most of the patients, immunologic remission was obtained by Subtotal Thyroidectomy except for their having recurrent hyperthyroidism. To acquire immunologic remission, hormonal remission, at least, would be necessary. Because no definite factor other than the size of the thyroid remnant related to postoperative thyroid function was elucidated, near-total Thyroidectomy rather than Subtotal Thyroidectomy is expected to be induced not only hormonal remission but also immunologic remission. It should be noted that a few patients achieved hormonal remission but not immunologic remission.
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preoperative change of thyroid stimulating hormone receptor antibody level possible marker for predicting recurrent hyperthyroidism in patients with graves disease after Subtotal Thyroidectomy
World Journal of Surgery, 1996Co-Authors: Kiminori Sugino, Takashi Mimura, Osamu Ozaki, Hiroyuki Iwasaki, Nobuyuki Wada, Akihiko MatsumotoAbstract:: To make the surgical treatment for Graves' disease more ideal, it is important to elucidate factors related to postoperative thyroid dysfunction in addition to thyroid remnant. Because TSH receptor antibody (TRAb) is thought to be one of the essential causes of Graves' disease, we investigated whether preoperative changes in serum TRAb levels are related to postoperative recurrent hyperthyroidism. Between 1987 and 1992 a total of 1520 patients with Graves' disease were treated by Subtotal Thyroidectomy. Of these patients 335 visited Ito Hospital with no history of drug treatment of their disease and were treated surgically after several courses of antithyroid drug (ATD) therapy. There were 68 males and 267 females with a mean age of 25.8 years. The mean follow-up period was 48 months (range 12-84 months). Factors analyzed by univariate and multivariate analysis were as follows: age, sex, duration of ATD treatment, weight of resected thyroid, weight of thyroid remnant, preoperative titer of MCHA, TRAb at the time of initial examination (TRAb1), TRAb at the time of surgery (TRAb2), and DeltaTRAb, the difference between TRAb1 and TRAb2 (DeltaTRAb = TRAb1 - TRAb2). The chi-square test was used for univariate analysis and a logistic model for multivariate analysis. Of this group, 119 patients were euthyroid (35.5%), 50 were hyperthyroid (14.9%), and 166 were hypothyroid (49.3%). Significant factors related to recurrent hyperthyroidism were weight of thyroid remnant and DeltaTRAb in both univariate and multivariate analyses. DeltaTRAb is a possible new marker for predicting postoperative recurrent hyperthyroidism. If the preoperative TRAb level is not improved by ATDs in patients with Graves' disease, the thyroid remnant should be made smaller.
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early recurrence of hyperthyroidism in patients with graves disease treated by Subtotal Thyroidectomy
World Journal of Surgery, 1995Co-Authors: Kiminori Sugino, Takashi Mimura, Osamu Ozaki, Hiroyuki Iwasaki, Nobuyuki Wada, Yoshio Kure, Akihiko Matsumoto, Kunihiko ItoAbstract:Prerequistes for surgical treatment of Graves' disease are that it can be done safely and that it is associated with a low incidence of recurrent hyperthyroidism. Early recurrence is especially undesirable. We studied 728 patients with Graves' disease treated by Subtotal Thyroidectomy using multivariate analysis in order to determine the factors related to early recurrence. The following factors were analyzed: age, sex, duration of medical treatment, weight of resected thyroid tissue, thyroid remnant size, preoperative level of thyroid-stimulating hormone (TSH) binding inhibitory immunoglobulin (TBII), and antimicrosomal hemagglutination antibody (MCHA). “Early recurrence” was defined as TSH suppression observed within the first year after surgery and continuing for at least 6 months. A total of 106 patients (14.6%) had early recurrence. Statistical analyses were performed by the chi-square test for univariate analysis and a logistic model for multivariate analysis. Significant factors were thyroid remnant size, MCHA, and TBII. These results indicated that TBII and MCHA are related to early recurrence of hyperthyroidism, and smaller remnant size is recommended for patients with a high MCHA titer or a high TBII level (or both) in order to avoid early recurrence.
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management of recurrent hyperthyroidism in patients with graves disease treated by Subtotal Thyroidectomy
Journal of Endocrinological Investigation, 1995Co-Authors: Kiminori Sugino, Takashi Mimura, O Ozaki, Hiroyuki Iwasaki, Nobuyuki Wada, Akihiko Matsumoto, Kunihiko ItoAbstract:If the aim of surgical treatment for Graves' disease is not permanent hypothyroidism, it is difficult to avoid recurrent hyperthyroidism completely. The management of recurrent hyperthyroidism, however, is neither easy nor obvious. Improvement in the sensitivity of TSH assay has allowed the diagnosis of latent hyperthyroidism. Little is known about the clinical course of latent hyperthyroidism. We studied the management and outcome of recurrent hyperthyroidism in patients with Graves' disease treated by Subtotal Thyroidectomy. Between January 1988 and August 1991, 1115 patients with Graves' disease were treated by surgery. Postoperative thyroid function was evaluated by free T3, free T4 and TSH measurements. One hundred seventy-five patients with suppressed TSH secretion for at least 6 months were categorized as having recurrent hyperthyroidism. Eighty patients (45.1%) also had elevated thyroid hormone levels, (group 1). The remaining 95 patients (54.9%) had normal thyroid hormone levels with suppressed TSH values (group 2). In group 1, 58 patients were treated with antithyroid drug (ATD), 12 with iodine and 10 with radioiodine (RI). Remission of Graves' disease was obtained in 22 patients (11 by ATD, 1 by iodine and 10 by Ri). On the other hand, patients in group 2 were followed up without medication, and spontaneous remission was observed in 21 of theln (22.1%). It was difficult to induce remission of overt recurrent Graves' disease by ATD or iodine. In contrast spontaneous remission could be obtained in some patients with postoperative latent hyperthyroidism.
