Thyroidectomy

Abstract

Most patients with diffuse hyperthyroidism or Grave’s disease are now treated with radioactive iodine. This method has the advantage of simplicity and safety, although a longer period of time is required to correct the hyperthyroidism than is necessary with surgery. Operating on a toxic thyroid gland is more difficult than excising a solitary adenoma. The gland is larger and more vascular, especially if the patient has been prepared with propylthiouracil or methimazole. A recent advance in this area has been the use of propanolol for the preoperative preparation of a toxic patient. When an adequate dose has been administered, the symptoms of hyperthyroidism disappear quite rapidly and the thyroid gland is less vascular than is the case after the more traditional preparatory medications. Nevertheless, even a highly skilled thyroid surgeon experiences a 5% morbidity rate, including laryngeal nerve damage (less than 1%) and permanent hypoparathyroidism (less than 1%). Transient postoperative hypoparathyroidism may occur in an additional 55–10% of cases.