What are the indications for surgical care in the treatment of Graves disease?

Updated: Apr 17, 2020
  • Author: Sai-Ching Jim Yeung, MD, PhD, FACP; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Indications and outcomes are as follows:

  • Thyroidectomy is not the recommended first-line therapy for hyperthyroid Graves disease in the United States. However, a retrospective cohort study [74] showed that one-third of all patients electing surgery as definitive management did so without a specific indication, and the patient satisfaction with the decision for surgery as definitive management of Graves disease was high. Surgery is a safe alternative therapeutic option in patients who are noncompliant with or cannot tolerate antithyroid drugs, have moderate-to-severe ophthalmopathy, have large goiters, or refuse or cannot undergo radioiodine therapy. Also, surgical treatment has been found to be more effective than radioiodine therapy to achieve cure and reduce recurrence. [75]

  • Thyroidectomy may be appropriate in the presence of a thyroid nodule that is suggestive of carcinoma.

  • In certain cases (eg, in pregnant patients with severe hyperthyroidism), thyroidectomy may be indicated because radioactive iodine and antithyroid medications may be contraindicated.

  • It generally is reserved for patients with large goiters with or without compressive symptoms.

  • It also may be indicated in patients who refuse radioiodine as definitive therapy or in those in whom the use of antithyroid drugs and/or radioiodine does not control hyperthyroidism.

  • Surgery provides rapid treatment of Graves disease and permanent cure of hyperthyroidism in most patients, and it has "negligible mortality and acceptable morbidity" by experienced surgeons. [76]

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