Summary of findings for the main comparison. Total thyroidectomy compared to subtotal thyroidectomy for Graves disease and Graves' opthalmopathy.
| Total thyroidectomy compared to subtotal thyroidectomy for Graves disease/Graves opthalmopathy | ||||||
| Patient: patients with Graves' disease/Graves' opthalmopathy Settings: university hospitals in Poland, Germany and Sweden Intervention: total thyroidectomy Comparison: subtotal thyroidectomy | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed riska | Corresponding risk | |||||
| Subtotal thyroidectomy | Total thyroidectomy | |||||
| Rate of recurrent hyperthyroidism [measured by thyroid function tests] Follow‐up: 6 months and 6 years | 55 per 1000 | 8 per 1000 (2 to 26) | OR 0.14 (0.04 to 0.46) | 350 (2) | ⊕⊕⊕⊝ moderateb | ‐ |
| Regression of Graves' ophthalmopathy [ophthalmology assessment] Follow‐up: 6 months and 6 years | 782 per 1000 | 805 per 1000 (697 to 882) | OR 1.15 (0.64 to 2.08) | 229 (2) | ⊕⊕⊝⊝ lowc |
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| Permanent recurrent laryngeal nerve palsy [patient reported, confirmation by laryngoscopy] Follow‐up: 6 months to 6 years | 18 per 1000 | 26 per 1000 (7 to 93) | OR 1.45 (0.38 to 5.59) | 393 (3) | ⊕⊕⊝⊝ lowd | ‐ |
| Permanent hypocalcaemia/hypoparathyroidism [measured by serum calcium levels] Follow‐up: 6 months to 6 years | 14 per 1000 | 59 per 1000 (16 to 190) | OR 4.79 (1.36 to 16.83) | 393 (3) | ⊕⊕⊝⊝ lowd | ‐ |
|
All‐cause mortality Follow‐up: 6 months to 6 years |
See comment | See comment | Not estimable | 350 (1) | See comment | Only one death reported in total thyroidectomy group |
| Health‐related quality of life | See comment | See comment | Not estimable | See comment | See comment | Not investigated |
| Socioeconomic effects | See comment | See comment | Not estimable | See comment | See comment | Not investigated |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; OR: Odds ratio; RR: Risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
aAssumed risk was derived from the event rates in the intervention comparator groups. bDowngraded by one level because of high risk of performance bias in both trials and reporting bias in one trial. cDowngraded by two levels because of high risk of performance bias in both trials and imprecision. dDowngraded by two levels because of high risk of performance bias in all trials, imprecision and low event rates.