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Surgery for thyrotoxicosis 

Surgery for thyrotoxicosis
Chapter:
Surgery for thyrotoxicosis
Author(s):

Mauricio Moreno

, Nancy D. Perrier

, and Orlo Clark

DOI:
10.1093/med/9780199235292.003.3198
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date: 12 December 2017

Surgical intervention plays a critical role in the management of thyrotoxicosis. Despite this, radioactive iodine is still the most popular treatment modality in the USA. Thyrotoxicosis, the condition of hyperthyroidism, is due to the increased secretion of thyroid hormone, and may be caused by toxic solitary nodules, toxic multinodular goitre (Plummer’s disease), or diffuse toxic goitre (Graves’ disease). Graves’ disease is the condition of goitre and associated clinical features of tachycardia and bulging eyes described by Dr Robert James Graves (1797–1853) in 1835 (1). Understanding the pathophysiology of the condition of thyrotoxicosis is essential in the appropriate selection of surgical candidates and planning the most suitable technique. Generally, accepted indications for thyroidectomy for thyrotoxicosis include: suspicion of malignancy by physical examination (firmness, irregularity, or attachment to local structures) or by fine-needle aspiration cytology of nodules; pregnancy; women desiring pregnancy within 6–12 months of treatment; lactation; medical necessity for rapid control of symptoms (patients with cardiac morbidity); local compression (pain, dysphagia); recurrence after antithyroid drug treatment; fear of radioactive iodine treatment; resistance to 131I or antithyroid drugs; or thyroid storm unresponsive to medical therapy. Other more relative indications for thyroidectomy also include: large goitres greater than 100 g that are less likely to respond to radioactive treatment and require a large treatment dose of 131I; severe Graves’ ophthalmopathy; poor compliance with antithyroid drugs; children and adolescents; a large, bothersome, and unsightly goitre; amiodarone-induced thyrotoxicosis, in cases when medical treatment is ineffective and amiodarone is necessary to treat cardiac disease; or hypersensitivity to iodine.

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