Our Summary

Graves’ disease is a condition where the body’s immune system mistakenly attacks the thyroid gland, leading to overproduction of thyroid hormones, a condition known as hyperthyroidism. This can cause heart problems, eye conditions, and other health issues. There are three main treatment methods for Graves’ disease: medication, radioactive iodine treatment, and surgical removal of the thyroid (thyroidectomy).

Of these, thyroidectomy is the least common, but it is the preferred choice for patients with a large thyroid gland causing discomfort, suspicious or cancerous growths in the thyroid, or severe eye problems. There has been a debate over the best surgical procedure for Graves’ disease. In the past, a partial removal of the thyroid was common, but in the last two decades, complete removal of the thyroid has become more common.

This paper reviews the history and current research, including controlled trials and systematic reviews, and concludes that complete thyroid removal is the best surgical option for Graves’ disease. It offers near-zero chances of the disease recurring, predictable post-surgery underactivity of the thyroid, and a low risk of complications. This is especially true if the surgery is performed by surgeons who frequently perform thyroid surgeries.

FAQs

  1. What is Graves’ disease and how does it affect the thyroid gland?
  2. What are the main treatment methods for Graves’ disease and when is thyroidectomy preferred?
  3. Why is complete thyroid removal considered the best surgical option for Graves’ disease?

Doctor’s Tip

A helpful tip a doctor might tell a patient about thyroidectomy is to follow post-operative instructions carefully to ensure proper healing and minimize complications. This may include taking prescribed medications, monitoring hormone levels, and attending follow-up appointments with your healthcare provider. It’s also important to maintain a healthy diet and lifestyle to support overall thyroid health. Additionally, be sure to communicate any concerns or changes in symptoms to your healthcare provider promptly.

Suitable For

Other patients who may be recommended for thyroidectomy include those with thyroid nodules that are causing symptoms such as difficulty swallowing or breathing, thyroid cancer, or hyperthyroidism that is not well controlled with medication or radioactive iodine treatment. Additionally, patients with thyroiditis (inflammation of the thyroid gland) or a goiter (enlarged thyroid gland) may also be candidates for thyroidectomy if other treatments are not effective. Ultimately, the decision to undergo thyroidectomy should be made in consultation with a healthcare provider based on individual circumstances and preferences.

Timeline

Before thyroidectomy:

  1. Patient is diagnosed with Graves’ disease based on symptoms, blood tests, and imaging studies.
  2. Patient may try medication or radioactive iodine treatment to manage symptoms, but if these are not effective or if the patient has specific indications for surgery, thyroidectomy may be recommended.
  3. Patient undergoes pre-operative evaluations, including blood tests, imaging studies, and consultations with an endocrinologist and surgeon.
  4. Patient may need to stop certain medications and follow specific dietary instructions in preparation for surgery.

After thyroidectomy:

  1. Patient undergoes surgery to remove part or all of the thyroid gland.
  2. Patient stays in the hospital for a few days for monitoring and recovery.
  3. Patient may experience temporary hoarseness, difficulty swallowing, or neck pain post-surgery.
  4. Patient may need to take thyroid hormone replacement medication for the rest of their life to regulate hormone levels.
  5. Patient follows up with their surgeon and endocrinologist for monitoring of hormone levels and overall health.
  6. Patient may experience improvements in symptoms related to hyperthyroidism, such as rapid heartbeat, weight loss, and tremors.
  7. Patient may need to make lifestyle changes, such as dietary adjustments and regular exercise, to manage their thyroid hormone levels and overall health.

What to Ask Your Doctor

Some questions a patient should ask their doctor about thyroidectomy for Graves’ disease include:

  1. What are the risks and benefits of thyroidectomy compared to other treatment options for Graves’ disease?
  2. What is the success rate of complete thyroid removal in treating Graves’ disease compared to partial removal?
  3. How experienced is the surgeon in performing thyroidectomies for Graves’ disease?
  4. What is the expected recovery time and potential complications after thyroidectomy?
  5. Will I need to take thyroid hormone replacement medication after the surgery?
  6. How will thyroidectomy affect my long-term health and quality of life?
  7. Are there any lifestyle changes or dietary restrictions I should follow after thyroidectomy?
  8. What follow-up care will be needed after the surgery?
  9. How likely is it for the Graves’ disease to recur after complete thyroid removal?
  10. Are there any alternative treatments or complementary therapies that may help manage Graves’ disease after thyroidectomy?

Reference

Authors: Bobanga ID, McHenry CR. Journal: Best Pract Res Clin Endocrinol Metab. 2019 Aug;33(4):101319. doi: 10.1016/j.beem.2019.101319. Epub 2019 Aug 31. PMID: 31530446