Subtotal thyroidectomy is the oldest form of therapy used for GD. Surgery, both partial and total thyroidectomy, has the advantage of allowing direct tissue examination, and it offers prompt resolution of symptoms. After surgery, thyroid function returns to normal in between 90% and 98% of patients.
Thyroidectomy is a particularly good choice for patients with very large goiters since they seldom respond adequately to RAI. Surgery is also recommended for patients who plan to eventually become pregnant or patients who react severely to ATDs.
The surgical procedure most frequently used is a subtotal thyroidectomy in which a rim of each lobe is left, leaving a total of 4-6 grams. The thyroid is usually prepared to facilitate cutting by administering strong iodine solution for 7 to 10 days prior to surgery.
The mortality of thyroidectomy is close to zero. However, there are two rare complications, recurrent laryngeal nerve damage and hypoparathyroidism, which occur in 1% to 2% of cases. Both conditions can cause lifelong disability. Other transient complications include hypocalcemia, post-operative bleeding, wound infection, keloid formation, and scars. Finding a well experienced surgeon is of paramount importance.
Hypothyroidism is said to occur in 12% to 50% of patients in the first year after surgery, and late onset hypothyroidism develops in an additional 1% to 3% of patients each year, although this may be due to the natural progression of the disease. Recurrences may develop many years after surgery. 43% of recurrences occur within 5 years after surgery. 1
Dr. Rebecca Sipple and her team at the University of Wisconsin School of Medicine recently announced the results of a study using thyroidectomy in Graves' patients. The study evaluated the medical records of 58 patients who had either partial or total thyroidectomy between 1994 and 2008. The patients self-reported that they tried radioiodine or anti-thyroid meds, which failed to control their disease.
While the study found that hyperthyroidism was cured by thyroidectomy, and the patients became hypothyroid quickly, there wasn't a long-term follow-up. Dr. Sipple therefore concluded that surgery is the most rapid method for obtaining definite control of the hyperthyroidism.
The researchers concluded that patients with Graves' disease should be told about the pros and cons of all 3 treatment options: anti-thyroid drugs, surgery and radioiodine. If patients decide on surgery they should find an experienced surgeon and be prepared to take lifelong replacement hormone. ♦
1 © 11 Mar 2006 Copyrighted by Elaine Moore
2 Source for Updates: Excerpt from "Thyroid Removal is Safe and Effective for Graves' Disease," University of Wisconsin School of Medicine and Public Health, February 15, 2011.
Copyrighted © by Elaine Moore