Total thyroidectomy in the management of thyrotoxic and euthyroid Graves' disease

Abstract

Total surgical thyroidectomy can be performed as safely as can subtotal thyroidectomy, as the latter is performed for Graves' disease. The benefits obtained from total surgical thyroidectomy are: (1) elimination of a diseased thyroid; (2) no recurrence of thyroid disease; (3) no initiation of ophthalmopathy when not existing at the time of surgery; (4) cessation in the progression of ophthalmopathy; (5) satisfactory regression of the infiltrative changes of Graves' disease; (6) markedly less amounts of I 131 required to eliminate ectopic, remnant, or microscopic thyroid tissue, when further treatment is indicated in the continued management of stationary ophthalmopathy. The small price paid by the patient for these benefits is the need to take thyroid for life. This is a relatively minor problem when one considers the fact that hypothyroidism is encountered in 35 to 70 per cent of patients treated by subtotal thyroidectomy or I 131 therapy. Because of the difficulty in prognosticating the evolution of eye pathology in Graves' disease, and based on our experience with I 131 and surgical ablation when these two modalities are under consideration in the presence of persistent or progressive ophthalmopathy, we suggest that total surgical thyroidectomy be selected as the treatment of choice as early as possible in the course of the disease.