***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Objective To examine the prevalence of outcome reporting bias — the selection for publication of a subset of the original recorded outcome variables on the basis of the results — and its impact on Cochrane review s. Design A nine point classification system for missing outcome data in r and omised trials was developed and applied to the trials assessed in a large , unselected cohort of Cochrane systematic review s. Research ers who conducted the trials were contacted and the reason sought for the non-reporting of data . A sensitivity analysis was undertaken to assess the impact of outcome reporting bias on review s that included a single meta- analysis of the review primary outcome . Results More than half ( 157/283 ( 55 % ) ) the review s did not include full data for the review primary outcome of interest from all eligible trials . The median amount of review outcome data missing for any reason was 10 % , whereas 50 % or more of the potential data were missing in 70 ( 25 % ) review s. It was clear from the publications for 155 ( 6 % ) of the 2486 assessable trials that the research ers had measured and analysed the review primary outcome but did not report or only partially reported the results . For reports that did not mention the review primary outcome , our classification regarding the presence of outcome reporting bias was shown to have a sensitivity of 88 % ( 95 % CI 65 % to 100 % ) and specificity of 80 % ( 95 % CI 69 % to 90 % ) on the basis of responses from 62 trialists . A third of Cochrane review s ( 96/283 ( 34 % ) ) contained at least one trial with high suspicion of outcome reporting bias for the review primary outcome . In a sensitivity analysis undertaken for 81 review s with a single meta- analysis of the primary outcome of interest , the treatment effect estimate was reduced by 20 % or more in 19 ( 23 % ) . Of the 42 meta-analyses with a statistically significant result only , eight ( 19 % ) became non-significant after adjustment for outcome reporting bias and 11 ( 26 % ) would have overestimated the treatment effect by 20 % or more . Conclusions Outcome reporting bias is an under-recognised problem that affects the conclusions in a substantial proportion of Cochrane review s. Individuals conducting systematic review s need to address explicitly the issue of missing outcome data for their review to be considered a reliable source of evidence . Extra care is required during data extraction , review ers should identify when a trial reports that an outcome was measured but no results were reported or events observed , and contact with trialists should be encouraged BACKGROUND No consensus exists on optimal treatment for Graves ' disease once anti-thyroid medication fails to induce remission . Total thyroidectomy is a more cost-effective treatment than radioactive iodine or life-long anti-thyroid medication , but hypocalcaemia is an important complication , leading to longer hospital admissions and increased prescription costs . This study aim ed to compare the relative risk of hypocalcaemia requiring medical treatment for patients with Graves ' disease . METHODS Prospect i ve cohort study of patients undergoing total thyroidectomy for Graves ' disease and for multinodular goitre , calculating serum calcium levels 24-hours post-operatively and prescription rates . RESULTS Mean corrected calcium concentrations 24 hours post-operatively were 2.05 mmol/l for Graves ' disease patients and 2.14 mmol/l for multinodular goitre patients ( p = 0.003 ) . Biochemical hypocalcaemia developed in 92 per cent ( n = 34 ) of Graves ' disease patients and 71 per cent ( n = 43 ) of multinodular goitre patients ( p = 0.012 ) . Graves ' disease patients were more likely to be prescribed calcium supplementation pre-discharge ( p = 0.037 ) . CONCLUSION Total thyroidectomy for Graves ' disease carries an increased risk of hypocalcaemia at 24 hours , and of calcium supplementation pre-discharge . Graves ' disease patients should be informed of the increased risk of hypocalcaemia associated with total thyroidectomy , and this risk must be factored into future cost-effectiveness analysis The effect of surgery on  Graves ' orbitopathy ( GO )  is still controversial . Retrospective analyses of many authors ( including our own group ) demonstrated GO improvement after subtotal thyroid resection in up to 70 % of operated patients , so the question arose whether total thyroidectomy could add anything to this pronounced positive effect on GO . We therefore performed a prospect i ve r and omized trial on 150 patients with Graves ' disease ( 125 women , 25 men ; mean thyroid volume 80.5 ml ) comparing three surgical procedures ( bilateral subtotal thyroid resection — total remnant < 4 ml ; unilateral hemithyroidectomy with contralateral subtotal thyroid resection — remnant < 4 ml ; total thyroidectomy ) and their effect on postoperative GO changes , postoperative thyroid-stimulating hormone receptor ( TSH-R ) antibody titers , and postoperative complication rates . After a period of at least 6 months ( 6–36 months ) GO had improved in 71 % to 74 % of all patients regardless of whether total or subtotal thyroidectomy was performed . TSH-R antibody titers showed no differences for the three surgical groups . Postoperative recurrent hyperthyroidism occurred in two patients with subtotal resections , and early postoperative hypoparathyroidism was more frequently detected in patients with total thyroidectomy than in those with subtotal thyroid resection ( 28 % vs. 12 % ; p < 0.002 ) . In respect to possible postoperative hypoparathyroidism and a lack of difference in postoperative GO changes , we do not advocate total thyroidectomy for patients with Graves ' disease and Graves ' orbitopathy but prefer radical subtotal thyroid resection with a remnant of less than 4 ml BACKGROUND Ophthalmopathy caused by Graves ' disease may first appear or worsen during or after treatment for hyperthyroidism . It is not known , however , whether choosing to treat hyperthyroidism with antithyroid drugs , iodine-131 , or surgery affects the development or aggravation of Graves ' ophthalmopathy . METHODS We studied 168 patients with hyperthyroidism caused by Graves ' disease , stratified into two age groups--20 to 34 years ( 54 patients , group 1 ) and 35 to 55 years ( 114 patients , group 2 ) . The patients in group 1 were r and omly assigned to treatment with methimazole for 18 months or subtotal thyroidectomy , and those in group 2 to either of these two treatments or to iodine-131 therapy . All the patients received thyroxine to avert hypothyroidism , except those treated with iodine-131 , who received thyroxine only if hypothyroidism developed . The duration of follow-up was at least 24 months . RESULTS Twenty-two patients ( 13 percent ) had infiltrative Graves ' ophthalmopathy at r and omization . During follow-up , ophthalmopathy developed for the first time in 22 patients ( 13 percent ) and worsened in 8 patients ( 5 percent ) . The frequency of the development or worsening of ophthalmopathy was similar among the patients in group 1 ( medical therapy , 4 of 27 patients [ 15 percent ] ; and surgery , 3 of 27 patients [ 11 percent ] ) . In group 2 , ophthalmopathy developed or worsened in 4 of the 38 patients ( 10 percent ) treated medically , 6 of the 37 patients ( 16 percent ) treated surgically , and 13 of the 39 patients ( 33 percent ) given iodine-131 ( P = 0.02 for the comparison between the iodine-131 subgroup and the others combined ) . The risk of the development or worsening of ophthalmopathy increased as pretreatment serum triiodothyronine concentrations increased . CONCLUSIONS As compared with other forms of antithyroid therapy , iodine-131 is more likely to be followed by the development or exacerbation of Graves ' ophthalmopathy Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background Graves ’ disease is an independent risk factor for transient postoperative hypoparathyroidism . Besides the disease itself , preparation techniques are influential . Transient postoperative hypoparathyroidism has severe consequences for patients ’ physical and psychological state . It can be life threatening during the acute phase and may impair patients ’ health , psyche and quality of life thereafter . For the surgical therapy of Graves ’ disease , total thyroidectomy is recommended according to the national S2- guideline . The evidence - based on a meta analysis - is criticized by the Cochrane diagnostic review commentary for substantial method ological deficits . Two r and omized controlled trials lead to the hypothesis that a near-total resection with bilateral remnants of ≤ 1 g on each side compared to total thyroidectomy will significantly reduce the occurrence of transient postoperative hypoparathyroidism with equal therapeutic safety . Methods / Design Patients with Graves ’ disease indicated for definite surgery are eligible for the trial . Trial-specific exclusion criteria are : conservative treatment , malignancy , previous thyroid surgery and coincident hypoparathyroidism . The trial is created for therapeutic purpose through process innovation . It is design ed as a prospect i ve r and omized controlled patient and observer blinded multicentered trial in a parallel design including an active comparator and an intervention group . The intervention addresses the surgical procedure : near-total thyroidectomy leaving bilateral remnants of ≤ 1 g on each side in the intervention group and total thyroidectomy in the control group . The occurrence of transient postoperative hypoparathyroidism is defined as primary endpoint . Secondary endpoints are : reoperations due to bleeding , recurrent laryngeal nerve palsy , permanent hypoparathyroidism , recurrent disease , changes of endocrine orbitopathy and quality of life within a one-year follow-up period . The primary efficacy analysis follows the intention-to-treat principle . A binary logistic regression model will be applied . Complications and serious adverse events will be descriptively analyzed . Discussion The trail is expected to balance out the shortcomings of the current evidence . It will define the surgical gold st and ard for the surgical therapy of Graves ’ disease . Patients ’ safety and quality of life are assumed to be enhanced . Therapy costs are likely to be reduced and health care optimized . The conduction of the trial is feasible through the engagement and commitment of the German association of endocrine surgeons and the National Network for Surgical Trials . Trial registration German clinical trials register ( DRKS ) Abstract . Graves ’ ophthalmopathy is a complex disease whose pathogenesis is thought to be autoimmune . The treatment of Graves ’ disease is considered to be related to the progression of Graves ’ ophthalmopathy . There have been no long-term prospect i ve studies on the natural course of Graves ’ ophthalmopathy . In this study we assessed the influence of subtotal thyroidectomy on the outcome of Graves ’ ophthalmopathy , comparing it with that of radioactive iodine treatment .  Altogether 287 untreated patients with Graves ’ disease referred to Ito hospital in 1989 were followed prospect ively for 5 years . A group of 67 patients were treated with radioactive iodine  , and 18 patients underwent surgery .  Proptosis of the eyes was measured in all patients using Hertel ’s exophthalmometer . The mean value of proptosis in patients with untreated Graves ’ disease was 14.8 ± 0.2 mm ( mean ± SEM ) , and after 5 years it increased slightly to 15.0 ± 0.2 mm . The mean changes of proptosis in patients treated surgically and patients given radioactive iodine were −0.01 ± 0.22 and 0.93 ± 0.28 mm , respectively ( p < 0.05 ) . In patients treated by subtotal thyroidectomy  , ophthalmopathy did not change in 77.8 % ; it progressed in 5.6 % and was alleviated in 16.7 % . In patients treated with radioactive iodine , the ophthalmopathy did not change in 86.6 % , progressed in 10.4 % , and was alleviated in 3.0 % . These findings indicate that surgery can be a better treatment than radioactive iodine for Graves ’ patients with ophthalmopathy OBJECTIVE The aim of this prospect i ve study was to report our results after  thyroidectomy for Graves ' disease . In addition , the relationship between the thyroid remnant and postoperative thyroid function was studied . MATERIAL AND METHODS Forty-nine consecutive patients were operated on for Graves ' disease . The indications for surgery were persistent or recurrent hyperthyroidism after medical treatment in 34 patients ( 69.4 % ) , mechanical symptoms due to a large goiter in 7 ( 14.3 % ) , increased ophthalmopathy in 7 ( 14.3 % ) , and allergy to antithyroid medications in 1 patient ( 2.0 % ) . Total thyroidectomy ( TT ) was performed in 28 and subtotal thyroidectomy ( STT ) in 21 patients . Follow-up lasted 24 to 70 months . RESULTS There was no statistically significant difference in the rate of postoperative complications comparing TT and STT . The patients who 
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AUTHORS ' CONCLUSIONS Total thyroidectomy is more effective than subtotal thyroidectomy ( both bilateral subtotal thyroidectomy and the Dunhill procedure ) at preventing recurrent hyperthyroidism in Graves ' disease .
The type of surgery performed does not affect regression of Graves ' ophthalmopathy .
There was some evidence that total thyroidectomy compared with subtotal thyroidectomy conferred a greater risk of permanent hypocalcaemia/hypoparathyroidism , which however , was not seen in comparison with bilateral subtotal thyroidectomy .
Permanent recurrent laryngeal nerve palsy did not seem to be affected by type of thyroidectomy .