Surgical Treatment Outcomes of Graves’ Disease: A Retrospective Multicenter Study in Ethiopia
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Date
2025-07
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Addis Ababa University
Abstract
Background: Graves’ disease (GD) is the most common cause of hyperthyroidism. In general, thyroidectomy is the preferred modality in the presence of severe eye disease, failure or contraindications to other treatment options, if rapid reversal of hyperthyroidism is needed, presence of concomitant suspicious thyroid nodules, large goiters with compressive symptoms, and pregnancy or breastfeeding states. Despite advancements in medical management, total thyroidectomy remains a definitive treatment, especially in resource-limited settings. However, data on surgical outcomes and predictors of complications in low-income countries remain limited.
Objective:
To evaluate the surgical treatment outcome of GD at our centers and to identify clinical and demographic predictors of unfavorable outcomes, including recurrent laryngeal nerve injury (RLNI) and permanent hypocalcemia.
Materials and methods: A years, multicenter retrospective study was conducted across four hospitals in Ethiopia from December 1, 2021 to December 31, 2024. A total of 43 patients for whom thyroidectomy done for GD were included. Data were analyzed using SPSS version 26. Bivariate and multivariate logistic regression analyses were employed to identify predictors of surgical outcomes. P<0.05 declared statistically significant. Favorable outcome was defined as the absence of RLNI or permanent hypocalcemia.
Result: The majority of patients were female (74.4%) with a mean age of 36.4 years. Total thyroidectomy was performed in 95.3% of cases. The most frequent symptoms/signs were goiter (95.3%), palpitations (72.1%), and exophthalmos (69.8%). Postoperative complications included permanent hypocalcemia (9.3%), RLNI (4.7%), external branch of superior laryngeal injury in 1patient, temporary hypocalcemia in 1 patient and seroma in 2patients. Favorable outcomes were achieved in 86% of patients. On multivariate analysis, exophthalmos was significantly associated with favorable surgical outcome (p = .020), with the AOR=15.83, 95% CI [1.53 – 163.55]. Other factors such as gender, comorbidities, duration of antithyroid drug therapy, and preop-thyroid function status were not statistically significant.
Conclusion: In well-prepared patients, surgical management of Graves’ disease is safe and effective, with high rates of favorable outcomes. Exophthalmos was identified as a strong independent predictor of favorable prognosis. These findings support early surgical referral and highlight the importance of surgeon expertise and preoperative optimization. Further prospective studies are recommended to confirm these findings and guide clinical practice.
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Keywords
Graves’ disease, Exophthalmos, hypocalcemia, recurrent laryngeal nerve injury, thyroidectomy, Ethiopia.