Surgery offers a definitive cure for hyperthyroidism when medical therapy fails or is poorly tolerated. Here is when to consider it.
Causes of hyperthyroidism
Graves' disease (the commonest), toxic multinodular goitre, and toxic adenoma. All cause excess thyroid hormone production.
First-line treatment
Anti-thyroid medication (carbimazole or PTU), sometimes combined with beta-blockers for symptom control.
When surgery is preferred
Failed or relapsed medical therapy; intolerance to anti-thyroid drugs; large compressive goitre; suspicion of cancer; patient preference for definitive cure; planning pregnancy.
Preparation
Patients are rendered biochemically euthyroid before surgery, often with Lugol's iodine for 10 days pre-operatively to reduce vascularity.
Outcome
Total thyroidectomy provides a definitive cure. Lifelong levothyroxine replacement is required.