Objective To investigate the feasibility and safety of endoscopic surgery for the treatment of primary hyperthyroidism with goiter.Methods A total of 140 patients with primary hyperthyroidism and different degrees of thyroid enlargements were included who underwent endoscopic surgeries via a trans breast approach in the Second Affiliated Hospital of Zhejiang University School of Medicine from 2013 to 2023,including 137 females and 3 males,aged from 16 to 49 years old.Thirty-one cases had normal thyroid size,25 cases had Grade Ⅰenlargement,56 cases had Grade Ⅱ enlargement,and 28 cases had Grade Ⅲ enlargement.Demographic characteristics,operative time,intraoperative blood loss,and postoperative complications were described,analyzed,and compared among groups.Student's t-test,Mann-Whitney U test,chi-square test,Fisher exact test or one-way analysis of variance(ANOVA)were used for statistical analyses.Results The patients with Grade Ⅲ enlargement were younger compared to other groups(F=5.58,P＜0.01),and also had significantly longer operative time(F=2.81,P=0.04).The probability of conversion to open surgery in the Grade Ⅲ enlargement group was 10.7％(3/28),significantly higher than other groups(0/31,0/25,1/56,x2=8.11,P=0.04).There were no significant differences among the four groups in terms of other demographic indicators and the incidences of postoperative complications(including recurrent laryngeal nerve injury,hypocalcemia,and surgical site infection).There was no significant difference in the probability of temporary hypoparathyroidism among the 4 groups.One patient with permanent hypoparathyroidism appeared respectively in the normal size group and Grade Ⅱ enlargement group.The average follow-up time was 4.2±3.7 years and 14 cases were lost to follow-up,and the patients had high satisfaction with"no neck scar"but with mild chest discomfort.Conclusion The risk of endoscopic thyroid surgery in the treatment of primary hyperthyroidism with goiter is controllable,and patients with hyperthyroidism combined with Grade Ⅲ enlargement should be especially vigilant against the risk of conversion to open surgery.
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