Surgical management of hyperthyroidism
- Douglas S Ross, MD
Douglas S Ross, MD
- Section Editor — Thyroid Disease
- Professor of Medicine
- Harvard Medical School
- Sonia L Sugg, MD
Sonia L Sugg, MD
- Associate Professor
- Division of Surgical Oncology and Endocrine Surgery
- University of Iowa Carver College of Medicine
The treatment of hyperthyroidism consists of both symptomatic relief and decreasing the production of thyroid hormone. The use of surgery as definitive therapy for hyperthyroidism varies with the cause of the disease and the characteristics of the patient.
Indications for surgical management of hyperthyroidism and preoperative preparation are reviewed here. Thyroidectomy is reviewed in detail elsewhere (see "Initial and reoperative thyroidectomy"). Other treatment options are also discussed elsewhere. (See "Radioiodine in the treatment of hyperthyroidism" and "Treatment of toxic adenoma and toxic multinodular goiter" and "Graves' hyperthyroidism in nonpregnant adults: Overview of treatment", section on 'Choice of therapy'.)
The approach outlined below is consistent with Hyperthyroidism Management Guidelines from the American Thyroid Association and the American Association of Clinical Endocrinologists .
Graves' disease — Patients with Graves’ disease can be treated with antithyroid drugs, radioiodine, or surgery. In the only randomized prospective trial comparing these three therapies, each was equally effective in normalizing serum thyroid hormone concentrations within six weeks; after treatment, 95 percent or more of the patients were satisfied with their therapy . Therefore, the choice of therapy should involve active discussion between clinician and patient (table 1) . The therapeutic approach to Graves' hyperthyroidism is reviewed in more detail elsewhere. (See "Graves' hyperthyroidism in nonpregnant adults: Overview of treatment", section on 'Choice of therapy'.)
A patient may prefer surgery over other modalities because of a desire to avoid radioiodine, avoid the potential side effects of antithyroid drugs, and to obtain rapid correction of hyperthyroidism. In addition, the following patients with Graves' hyperthyroidism may be better served by surgery:
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- Graves' disease
- Toxic adenoma and toxic multinodular goiter
- EXTENT OF RESECTION
- PREOPERATIVE PREPARATION
- Beta blockers
- Thionamide therapy
- - Patients unable to take a thionamide drug
- FOLLOW-UP AND MONITORING
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS