Thyroidectomy for Selected Patients With Thyrotoxicosis

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Abstract
THYROTOXICOSIS is a syndrome characterized by signs and symptoms of hypermetabolism and increased sympathetic nervous system activity that results from excessive thyroid hormone. The most common cause of thyrotoxicosis is Graves' disease, accounting for 60% to 90% of all cases of thyrotoxicosis.1 Toxic multinodular goiter and a solitary toxic nodule are less common causes of thyrotoxicosis. The treatment alternatives for thyrotoxicosis include antithyroid drugs, thyroid ablation with iodine 131 (131I), and thyroidectomy. In the United States, 131I is the predominant modality used for treatment of thyrotoxicosis.2,3 Many clinicians have questioned the necessity of surgical therapy for thyrotoxicosis. At one large tertiary care institution, only 3 patients with Graves' disease were treated with thyroidectomy during a 25-year period.4 Factors that need to be considered when deciding on an appropriate treatment plan for patients with thyrotoxicosis include patient age; associated ophthalmopathy; the size of the thyroid gland; the presence of compressive symptoms, substernal thyroid extension, or a concomitant dominant nodule; contraindications to the use of radioiodine; intolerance to antithyroid drugs; response to previous therapy; and patient preferences. The purpose of this study was to determine how often thyroidectomy is performed for treatment of thyrotoxicosis, delineate the reasons why patients with thyrotoxicosis are referred for thyroidectomy, and assess the efficacy and outcome of surgical therapy for thyrotoxicosis.