Risk of Complications in Patients Undergoing Thyroidectomy for Graves' Disease (LUNA Study)

Objective: To evaluate the risk of complications in patients with Graves' disease undergoing thyroidectomy by high-volume surgeons. Study Design: Retrospective, multicenter, international study. Setting: Data were obtained from 5 centers in Europe. Methods: Patients undergoing total thyroidectomy between 2019 and 2023 were analyzed. Enrolled patients were divided in 2 groups: GD Group, including those with Graves' disease, and C Group (control group). Complications were assessed after performing propensity score matching (1:1). Results: Based on inclusion/exclusion criteria, 8518 patients were enrolled: 1067 in GD Group and 7451 in C Group. Following propensity score matching, the study population consisted of 1068 patients: 534 in GD Group and 534 in C Group. In GD Group, there were 84 (15.73%) cases of postoperative hypoparathyroidism (65, 12.17%, temporary and 19, 3.56%, permanent), 15 (2.81%) unilateral recurrent laryngeal nerve lesions, 1 (0.19%) bilateral recurrent laryngeal nerve lesion, 15 (1.40%) temporary recurrent laryngeal nerve lesions, 2 (0.19%) permanent recurrent laryngeal nerve lesions, 22 (4.12%) neck hematomas (17, 3.18%, managed conservatively and 5, 0.94%, requiring surgical revision of hemostasis), and 2 (0.37%) wound infections. Overall postoperative hypoparathyroidism, permanent hypoparathyroidism, unilateral recurrent laryngeal nerve injury, and temporary recurrent laryngeal nerve injury were significantly greater in GD Group. Other complications were comparable. Conclusion: Complications were greater in patients with Graves' disease, however occurrence rates were low. Based on our findings, it can be stated that thyroidectomy in patients with Graves' disease, even for high-volume surgeons, represents a more challenging procedure, but it can nevertheless be considered a valid therapeutic option.