Customized Treatment of Graves' Disease by Transoral Endoscopic Thyroidectomy Vestibular Approach: A Retrospective Cohort Study with Long-term Follow-up

Purpose Graves' Disease (GD) management often requires surgical intervention when medical therapy fails. The Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) has emerged as a promising scarless technique. This study evaluates the efficacy, safety, and cosmetic outcomes of customized TOETVA techniques in GD treatment. Methods We conducted a retrospective analysis of 33 GD patients who underwent TOETVA between January 2019 and March 2024. Patients received one of three procedures: Total Thyroidectomy (TT, n = 11), bilateral Subtotal Thyroidectomy (ST, n = 7), or Dunhill procedure (Dh, n = 15). Outcomes were assessed over a 6–69 month follow-up period. Results TT and Dh were significantly more effective in preventing recurrent hyperthyroidism compared to ST (0/26 vs. 4/7, p < 0.006). The Dh group showed a higher incidence of postoperative hypothyroidism than ST (13/15 vs. 2/7, p < 0.001). Temporary hypoparathyroidism was more common in the TT group (3/11 vs. 0/22, p = 0.037). Intraoperative blood loss was significantly higher in the ST group (175.71 ± 299.38 ml) compared to Dh (27 ± 61.99 ml) and TT (4.91 ± 3.24 ml) groups (p < 0.001). No permanent hypoparathyroidism or recurrent laryngeal nerve injuries were observed. Conclusion Customized TOETVA for GD demonstrates safety and efficacy, with TT and Dh showing superior outcomes in preventing recurrent hyperthyroidism. The choice of technique should be tailored to individual patient factors, balancing the risks of recurrence and postoperative thyroid dysfunction.