Graves' disease surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Thyroidectomy is recommended for some patients including, patients with large goiters, women wishing to become pregnant shortly after treatment, patients who want to avoid exposure to antithyroid drugs or radioiodine.

Surgery

The patients’ thyroid hormone must be normalized before surgery to minimize the risk of surgery.
Treatment with inorganic iodide commencing 1 week before surgery may decrease thyroid blood flow, vascularity, and blood loss but does not otherwise influence surgical risk.^[1]
Surgery is recommended for:^[2]

Patients with large goiters
Women wishing to become pregnant shortly after treatment
Patients who want to avoid exposure to antithyroid drugs or radioiodine.

The course of ophthalmopathy is not affected by thyroidectomy.

	Advantages	Disadvantages
Thyroidectomy	Rapid euthyroidism Extremely rare recurrence No radiation hazard Definitive histologic results Rapid relief of pressure symptoms	Most expensive therapy Surgery and anesthesiology associated risks Major complications in 1-4% (hypoparathyroidism, recurrent laryngeal nerve damage)

References

↑ Erbil Y, Ozluk Y, Giriş M, Salmaslioglu A, Issever H, Barbaros U, Kapran Y, Ozarmağan S, Tezelman S (2007). “Effect of lugol solution on thyroid gland blood flow and microvessel density in the patients with Graves’ disease”. J. Clin. Endocrinol. Metab. 92 (6): 2182–9. doi:10.1210/jc.2007-0229. PMID 17389702.
↑ Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA, Ross DS, Sosa JA, Stan MN (2011). “Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists”. Endocr Pract. 17 (3): 456–520. PMID 21700562.

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[pmid17389702-1] Erbil Y, Ozluk Y, Giriş M, Salmaslioglu A, Issever H, Barbaros U, Kapran Y, Ozarmağan S, Tezelman S (2007). “Effect of lugol solution on thyroid gland blood flow and microvessel density in the patients with Graves’ disease”. J. Clin. Endocrinol. Metab. 92 (6): 2182–9. doi:10.1210/jc.2007-0229. PMID 17389702.

[pmid21700562-2] Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA, Ross DS, Sosa JA, Stan MN (2011). “Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists”. Endocr Pract. 17 (3): 456–520. PMID 21700562.

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