Advantages and disadvantages of surgical therapy and optimal extent of thyroidectomy for the treatment of hyperthyroidism

Surgery represents an excellent therapy for hyperthyroidism. There is no mortality, and there are few complications or recurrences. It allows a rapid and consistent method of achieving euthyroidism, avoids the long-term risks of radioactive iodine and antithyroid medications, provides tissue for histology, renders childbearing immediately possible, and allows absolute titration of thyroid hormone. Modern advancements, such as preoperative preparation and intraoperative PTH monitoring, have decreased greatly the risks of thyroid surgery and improved patient outcomes. Although there are several approaches to thyroidectomy, Hartley-Dunhill procedure is the treatment of choice. Patients should be rendered euthyroid before operation to decrease thyroid vascularity, to improve surgical planes, and to prevent life-threatening thyroid storm. Patients must be monitored carefully for hypocalcemia, a potentially serious complication of surgery. Patients will require lifelong thyroid hormone replacement. Radioactive iodine ablation should be considered for disease recurrence after surgery.