The top four reasons that surgery for Graves’ disease may be the best treatment

Graves’s disease is a process where the body is fighting itself and producing small immune proteins called antibodies that attach to the thyroid gland.  When these antibodies attach to the thyroid gland it leads to the overproduction of thyroid hormone and often an enlargement of your thyroid gland itself (goiter). Graves’ disease is the most common cause of hyperthyroidism (the overproduction of thyroid hormone). The diagnosis of Graves’ disease can be confirmed with a simple blood test looking for elevated self-antibody against your thyroid gland.  

Surgery for Graves’ disease has been a long standing approach to manage this process.  Over the years, many treatment options have developed for Graves’ disease.  Today, surgery for Graves’ disease, has once again emerged as the preferred treatment for many patients with Graves’ disease.  But it is important to understand that there are other ways to treat Graves’ disease, as well.  Those treatments include medical therapy (Methimazole and Propothiouracil) that decreases the production of the thyroid hormone overproduction that is seen in Graves’ disease.  It may also include medications that block the effects of rapid heart rate from the excessive thyroid hormone.  Radioactive iodine is another potential treatment for Graves’ disease as well. 

Personalized therapy is choosing the right treatment, for the right disease, that best suits each individual patient.  Surgery for Graves’ disease may be the best treatment for many patients and can be accomplished through several different approaches.  Surgery for Graves’ disease may include minimally invasive thyroid surgery, robotic thyroid surgery which does not produce a neck incision as well as transoral thyroid surgery which uses an incision within the mouth.  The best surgery for Graves’ disease requires the expert safe removal of the entire thyroid gland no matter which approach is chosen. 

#1 Reason that surgery for Graves’ disease is the best treatment:  The thyroid gland is very large

When Graves’s disease is diagnosed and the thyroid gland is very enlarged, surgery for Graves’ disease is most often the best treatment.  Surgery for Graves’ disease should be complete removal of the thyroid gland. The enlarged thyroid gland may be quite noticeable in the neck in some patients but may be well hidden in other patients due to the overlying muscles or extension of the thyroid gland below the collar bone into the chest area.  No matter how enlarged the thyroid gland (often called a goiter) or how low the thyroid gland extends into the chest, surgery for Graves’ disease is the preferred treatment and should only be performed by experts in thyroid surgery. 

#2 Reason that surgery for Graves’ disease is the best treatment:  The Graves’ disease has affected my eyes

Thyroid eye disease, Graves’ eye disease, or proptosis (the medical term where the eyes are bulging from their sockets) is a potential complication of Graves’ disease.  Sometimes this can be very slow to evolve and patients and their family members may not notice its slow development.   The eye disease may also progress very quickly, producing double or blurred vision and in rare circumstances even take away a patient’s vision.  In our opinion, every patient with Graves’ disease should be evaluated by an ophthalmologist to measure and evaluate eye function. 

Long standing Graves’ eye disease is not a reversible process.  It will not get better on its own but your doctors do not want it to get worse.  Surgery for Graves’ disease requires complete removal of the thyroid gland.  Total thyroidectomy prevents further progression of Graves’ eye disease and is an immediate cure of the process.  For this reason, surgery is the preferred treatment for patients with Graves’ eye disease.  

The best surgery for Graves’ disease is complete expert removal of the entire thyroid gland.  This is called a total thyroidectomy.  This is the preferred surgery for patients with Graves’ eye disease.  

#3 Reason that surgery for Graves’ disease is the best treatment: Radioactive iodine therapy is not desired or safe

Radioactive iodine has been used in the management of Graves’ disease for decades but has largely fallen out of favor.  When Graves’ eye disease is present or patients are pregnant or desire to have children in the near future, radioactive iodine therapy is usually not indicated.  In patients with enlarged thyroid glands as well, radioactive iodine therapy is infrequently considered due to its lack of efficacy in enlarged glands and often the need for repeat treatment due to ineffective therapy.  Additionally, radioactive iodine has fallen out of favor in the management of Graves’ disease due to the concerns of radiation exposure to other organs in the body and the risk of developing radiation induced cancers such as leukemia, lymphoma, and breast cancer (as examples).  For these reasons, surgery for Graves’ disease has once again emerged as the preferred treatment.

#4 Reason that surgery for Graves’ disease is the best treatment: Medical therapy is not working, unstable, or complications have developed

You can certainly take medication to attempt to control Graves’ disease.  There are two medications which are commonly used.  These medications reduce the production of thyroid hormone.  One is called methimazole and the other is called propothiouracil (PTU).  Methimazole is more commonly prescribed because it has less long term complications and side effects as compared to PTU.  Some rare patients will be completely controlled with methimazole and go into remission after a prolonged history of treatment and be able to be reduced to a small amount of methimazole as a maintenance medication and in some instances it can even be discontinued.  PTU works much more quickly than methimazole but is not considered in long term therapy for Graves’ disease due to its high risk of liver toxicity and complications.

Many patients do not do well with these medical therapies for Graves’ disease.  Often their disease becomes difficult to consistently control and they can experience roller coaster symptoms of very high thyroid hormone levels followed by periods of very low thyroid hormone production.  After a period of treatment, many patients get exhausted by these roller coaster hormone “rides” and seek surgery for Graves’ disease.  You can see what patients say about surgery for Graves’ disease at the following link.  Patients find relief in seeking surgery for Graves’ disease in that they return to a normal life again in exchange for taking a thyroid hormone pill on a daily basis.

Learn more about surgery for Graves’ disease.

Additional Resources

• Become our patient by filling out the form at this link. 
• Learn more about The Clayman Thyroid Center here. 
• Learn more about our sister surgeons at the Scarless Thyroid Surgery Center, Norman Parathyroid Center, and Carling Adrenal Center
• Learn more about the Hospital for Endocrine Surgery.