Treatment of Graves' Disease: The Advantages of Surgery

Surgical Management of Graves' Disease -10-year Prospective Trial at a Single Institution-

“…In North America, radioiodine therapy is usually preferred over thyroidectomy for the majority of patients [1]. However, some reports [2,3] from the United States have emphasized the advantages of thyroidectomy for Graves' disease and recommended thyroidectomy for selected patients. Thyroidectomy is more common in Asian countries than in North America and European countries.…”

Total Thyroidectomy for Graves’ disease – Our Experience

“…By the end of the twentieth century, STT and D were the most commonly applied operation in the surgical treatment of GD on the grounds that the complications (postoperative hypoparathyroidism and recurrent laryngeal nerve palsy) were less frequent compared to TT. At the beginning of the twenty-first century, it became clear that STT and D were linked to a high risk of relapse of GD [9,10] and surgeons in specialized centres started to use TT as the operation of choice in the treatment of GD. In addition to that, the fact that TT removes the target organ for GD leads to the elimination of the autoimmune stimulus and improvement of the ophthalmopathy in these patients [11] .…”

“…In addition to that, the fact that TT removes the target organ for GD leads to the elimination of the autoimmune stimulus and improvement of the ophthalmopathy in these patients [11] . Also, TT permanently removes the risk of cancer in patients already having it, as TT represents an adequate surgical intervention both for GD and for carcinoma of the thyroid gland [9] .…”

“…Even when the initial treatment is surgery, the choice of the primary treatment option depends on the adequate cooperation of an endocrineologist, a specialist in nuclear medicine and an endocrine surgeon [12] . The choice of an adequate operation for GD is still the subject of debate [13] , although after the year 2000, TT has become the treatment of choice for GD in many highly specialized centres in the world [9,14,15] .…”

“…According to the data of the American Thyroid Association, surgery is, in the US, a method of treatment in only 2% of patients with GD and only in 7% of patients with GD and thyromegaly [17] . Total or near total thyroidectomy is recommended for patients with ongoing thyroid cancer, those who refuse radio-ablation as a therapeutic procedure, or have a life threatening reaction to antithyroid drugs such as vasculitis, agranulocytosis and liver failure [9] . Total thyroidectomy is recommended to patients with Graves' ophthalmopathy to eliminate the autoimmune stimulus from the orbital antigens [11,18] .…”