When is surgery used to treat Thyrotoxicosis?

Surgery is used to treat thyrotoxicosis in the following circumstances:

• As patient preference
• In cases where there is a very large goitre
• When an allergy to all antithyroid drugs exists
• When there is severe thyroid eye disease
• In uncontrolled disease in pregnancy
• In suspected cancer of the thyroid.

How is surgery performed in Thyrotoxicosis?

The surgery is very similar to that for simple goitre. It is impossible in the individual case to know exactly how much thyroid tissue to leave behind. If the patient is happy to be on long-term thyroid replacement, then the most pragmatic approach is to perform a virtual total thyroidectomy with a zero risk of recurrent thyrotoxicosis. Some patients are violently against long-term thyroid replacement; these patients should be treated with a subtotal thyroidectomy leaving 8 grams of thyroid tissue behind. When a subtotal thyroidectomy is performed the patient must be warned of a 5-10% risk of recurrence, and there is still a 30-50% risk of a need for long-term thyroid replacement.

What is the long-term follow up after thyroid surgery for Thyrotoxicosis?

Patients who have been treated by total thyroidectomy and thyroid replacement need minimal follow up, maybe yearly thyroid function tests. Patients treated by subtotal thyroidectomy should be reviewed 6 monthly because they are at risk of recurrent hyperthyroidism as well as hypothyroidism. It is probably wise not to discharge patients from the clinic.