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. 2015 Nov 25;2015(11):CD010576. doi: 10.1002/14651858.CD010576.pub2
  Rate of recurrent hyperthyroidism Permanent recurrent laryngeal nerve palsy Permanent hypocalcaemia/hypoparathyroidism Regression of Graves' ophthalmopathy Health‐related quality of life Socioeconomic effects Severe/serious adverse events
Barczynski 2012 Laboratory tests included measurement of serum free tri‐iodothyronine (fT3; reference range 0.22 to 6.78 pmol/L), free thyroxine (fT4; reference range 12 to 30 pmol/L) and thyroid‐stimulating hormone (TSH, thyrotropin; reference range 0.4 to 4.2 units/L). A serum thyrotropin binding inhibitory immunoglobulin (TBII) level > 1.5 units/L was defined as positive Vocal cord paresis for more than 12 months after the operation was regarded as permanent
Indirect laryngoscopy was performed before surgery
Persistent hypocalcaemia with serum PTH level below 10 ng/L for more than 12 months The following definitions were used: a change in TES and/or CAS of fewer than 2 points from the preoperative baseline value was regarded as ‘no change’, an increase in TES and/or CAS of 2 points or more was regarded as‘progression’, and a decrease in TES and/or CAS of 2 points or more was regarded as ‘improvement’
Assessed by blinded ophthalmologist
Measured at yearly intervals for 5 years postop
N/I N/I One death reported (due to a myocardial infarction 3 years after surgery)
Chi 2005 Suppressed TSH (human TSH radioimmunoassay kit measured between 3‐26.4 months after surgery RLN palsy defined as permanent if longer than 6 months
Based on independent ENT specialist assessment and patient report
Permanent hypocalcaemia if longer than 6 months postop.. Assessed by external laboratory N/I N/I N/I N/I
Jarhult 2005 N/I RLN palsy considered permanent if persisting > 9 months (unclear whether laryngoscopy was performed) Persistent hypocalcaemia > 9 months 1. Improvement in ophthalmological score (based on author experience, not validated)
2. Improvment in objective and subjective evaluation of eye symptoms by patient and ophthalmologist
N/I N/I N/I
Witte 2000 N/I RLN palsy defined as permanent if longer than 6 months
Assessed by independent ENT specialist
Permanent hypocalcaemia if longer than 6 months postop.. Assessed by external laboratory GO measured from > 18‐58 months postop using standardised scale
Both patient reported and ophthalmology assessment scores are reported
N/I N/I N/I
Muller 2001 Biochemical tests of TSH, fT3 and fT4 with reference levels as per local laboratory. Suppressed TSH and elevated fT3/fT4 was taken to be evidence of hyperthyroidism (measured at 6 years) Recurrent laryngeal nerve palsy defined by impaired vocal cord movement seen on laryngoscopy (preop and postop laryngoscopy routine). Considered permanent if persisting more than 1 year Hypocalcaemia persisting more than 1 year was considered to be permanent Surgical team/physician assessment
Unclear what scale was used or whether an ophthalmologist was involved
Outcome measured at 6 years
N/I N/I No deaths
CAS: clinical activity score; ENT: ear, nose & throat; fT3: free tri‐iodothyronine; fT4: free thyroxine; GO: Graves' ophthalmopathy; N/I: not investigated; PTH: parathyroid hormone; RLN: recurrent laryngeal nerve; TES: total eye score; TT: total thyroidectomy; TSH: thyroid‐stimulating hormone