Graves' disease is an autoimmune disorder that results into overproduction of thyroid hormones.
Thyrotoxicosis signs and symptoms include hyperactivity, irritability, insomnia, dysphoria, sweating, heat intolerance, palpitations, weakness, fatigue, weight loss despite increased appetite, diarrhea, steatorrhea polyuria, decreased libido, tachycardia, tremor, goiter, alopecia, gynecomastia, eyelid lag or retraction and rarely periodic paralysis.
Clinical features in thyrotoxic patient that suggests Graves's disease are ophthalmopathy, thyroid dermopathy, thyroid acropachy, diffuse goiter, antibodies to thyroid peroxidase or thyroglobulin and thyroid radionuclide scan demonstrating a diffuse goiter.

Surgical Intervention

  • Surgery is not the1st-line treatment; pharmacotherapy is usually preferred over surgery
  • Near-total or total thyroidectomy is the preferred surgery
  • Effects: Up to 98% success rate when performed by experienced surgeons
  • May be option for:
    • Suspected thyroid cancer (excision of thyroid nodules to rule out malignancy)
    • Patients who want unsightly goiter removed
    • Patients who refuse radioactive iodine & want definitive treatment
    • Pregnant patients who are intolerant of antithyroid agents
    • Some physicians prefer surgery in pediatric/adolescent patients, esp if large goiter
  • Potential complications: Hypoparathyroidism, laryngeal edema, hemorrhage & nerve damage
Prior to Surgery
  • Restoration of euthyroidism to decrease risk of thyrotoxic storm
    • Antithyroid drug treatment prior to surgery, w/ or w/o inorganic iodide given x 7-10 days prior to surgery to block thyroid hormone synthesis
    • Inorganic iodide given x 7-10 days prior to surgery to block thyroid hormone synthesis (controversial)
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