[Role of surgery in treatment of hyperthyroidism]

Hyperthyroidism is treated with antithyroid drugs, radioactive iodine or surgery. The aim of surgery is to obtain long-lasting euthyroidism with a minimal risk of recurrence, secondary hypothyroidism, and complications involving the recurrent nerve or the parathyroids. Depending on the etiology, total or partial resection is indicated in light of these objectives. According to the literature, surgery is not used as first intention treatment for Grave's disease, its role and indications remaining a question of debate. However, surgery is the treatment of choice for toxic nodules, current consensus favoring extracapsular total lobectomy. For multinodular toxic goiter, three are several surgical indications: failure of medical treatment, relapse after drug withdrawal, specific clinical or socioeconomic situations requiring rapid efficacy. Total lobectomy associated with subtotal contralateral hemithyroidectomy appears to be the most appropriate procedure. Surgery may also be indicated for treatment of pregnancy-, diabetes-, or amiodarone-induced hyperthyroidism.