Summary of findings 3. Bilateral subtotal thyroidectomy compared to the Dunhill procedure for Graves disease and Graves' opthalmopathy.
| Bilateral subtotal thyroidectomy compared to the Dunhill procedure for Graves disease/Graves' opthalmopathy | ||||||
| Patient: patients with Graves disease/Graves' opthalmopathy Settings: university hospitals in Taiwan and Germany Intervention: bilateral subtotal thyroidectomy Comparison: Dunhill procedure | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed riska | Corresponding risk | |||||
| Dunhill procedureb | Bilateral subtotal thyroidectomy | |||||
| R ate of recurrent hyperthyroidism [measured by thyroid function tests] Follow‐up: 6 months to 6 years | 26 per 1000 | 68 per 1000 (33 to 135) | OR 2.73 (1.28 to 5.85) | 592 (3) | ⊕⊕⊝⊝ lowc | ‐ |
| Regression of Graves' ophthalmopathy [ophthalmology assessment] Follow‐up: 6 months and 6 years | 689 per 1000 | 633 per 1000 (415 to 810) | OR 0.78 (0.32 to 1.92) | 90 (2) | ⊕⊕⊝⊝ lowd |
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| Permanent recurrent laryngeal nerve palsy [patient reported, confirmation by laryngoscopy] Follow‐up: 6 months to 6 years | 3 per 1000 | 0 per 1000 (0 to 22) | OR 0.14 (0.00 to 6.82) | 592 (3) | ⊕⊕⊝⊝ lowc | ‐ |
| Permanent hypocalcaemia/hypoparathyroidism [measured by serum calcium levels] Follow‐up: 6 months to 6 years | 10 per 1000 | 18 per 1000 (5 to 70) | OR 1.90 (0.47 to 7.71) | 592 (3) | ⊕⊕⊝⊝ lowc | ‐ |
| All‐cause mortality Follow‐up: 6 months to 6 years | See comment | See comment | Not estimable | 642 (3) |
See comment | No deaths reported in any study |
| 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 bDunhill procedure: unilateral total and contralateral subtotal thyroidectomy cDowngraded by two levels because of high risk of performance bias in all trials, attrition bias in one of three trials, imprecision and low event rates dDowngraded by two levels because of high risk of performance bias in both trials, attrition bias in one of two trials, imprecision and low number of participants