Graves' disease surgery: Difference between revisions

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== Surgery ==
== Surgery ==
*The patients' thyroid hormone must be normalized before surgery to minimize the risk of surgery.
*The patients' thyroid hormone must be normalized before surgery to minimize the risk of surgery.
*Treatment with inorganic iodide commencing 1 week before surgery may decrease thyroid blood flow, vascularity, and blood loss but does not otherwise influence surgical risk.
*Treatment with inorganic iodide commencing 1 week before surgery may decrease thyroid blood flow, vascularity, and blood loss but does not otherwise influence surgical risk.<ref name="pmid17389702">{{cite journal |vauthors=Erbil Y, Ozluk Y, Giriş M, Salmaslioglu A, Issever H, Barbaros U, Kapran Y, Ozarmağan S, Tezelman S |title=Effect of lugol solution on thyroid gland blood flow and microvessel density in the patients with Graves' disease |journal=J. Clin. Endocrinol. Metab. |volume=92 |issue=6 |pages=2182–9 |year=2007 |pmid=17389702 |doi=10.1210/jc.2007-0229 |url=}}</ref>
*Surgery is recommended for some patients including,
*Surgery is recommended for some patients including,<ref name="pmid21700562">{{cite journal |vauthors=Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA, Ross DS, Sosa JA, Stan MN |title=Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists |journal=Endocr Pract |volume=17 |issue=3 |pages=456–520 |year=2011 |pmid=21700562 |doi= |url=}}</ref>
#Patients with large goiters  
#Patients with large goiters  
#Women wishing to become pregnant shortly after treatment
#Women wishing to become pregnant shortly after treatment
#Patients who want to avoid exposure to antithyroid drugs or radioiodine.
#Patients who want to avoid exposure to antithyroid drugs or radioiodine.
*The course of ophtalmopathy is not affected by thyroidectomy.
*The course of ophtalmopathy is not affected by thyroidectomy.
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* Major complications in 1-4% (hypoparathyroidism, recurrent laryngeal nerve damages)
* Major complications in 1-4% (hypoparathyroidism, recurrent laryngeal nerve damages)
|}
|}
Advantages of thyroidectomy include:
*
*
*No radiation hazard
*Definitive histologic results
*Rapid relief of pressure symptoms





Revision as of 14:31, 21 December 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]

Overview

Surgery

  • The patients' thyroid hormone must be normalized before surgery to minimize the risk of surgery.
  • Treatment with inorganic iodide commencing 1 week before surgery may decrease thyroid blood flow, vascularity, and blood loss but does not otherwise influence surgical risk.[1]
  • Surgery is recommended for some patients including,[2]
  1. Patients with large goiters
  2. Women wishing to become pregnant shortly after treatment
  3. Patients who want to avoid exposure to antithyroid drugs or radioiodine.
  • The course of ophtalmopathy is not affected by thyroidectomy.


Advantages Disadvantages
Thyroidectomy
  • Rapid euthyroidism
  • Extremely rare recurrence
  • No radiation hazard
  • Definitive histologic results
  • Rapid relief of pressure symptoms
  • Most expensive therapy
  • Surgery and anesthesiology associated risks
  • Major complications in 1-4% (hypoparathyroidism, recurrent laryngeal nerve damages)


References

  1. Erbil Y, Ozluk Y, Giriş M, Salmaslioglu A, Issever H, Barbaros U, Kapran Y, Ozarmağan S, Tezelman S (2007). "Effect of lugol solution on thyroid gland blood flow and microvessel density in the patients with Graves' disease". J. Clin. Endocrinol. Metab. 92 (6): 2182–9. doi:10.1210/jc.2007-0229. PMID 17389702.
  2. Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, Laurberg P, McDougall IR, Montori VM, Rivkees SA, Ross DS, Sosa JA, Stan MN (2011). "Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists". Endocr Pract. 17 (3): 456–520. PMID 21700562.

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