Surgery for hyperthyroidism: indications, pretreatment, operative strategy and results

In an endemic area nodular toxic goitre is the dominating type of hyperthyroidism, while Graves' or Basedow's disease with diffuse toxic goitre accounts for only 25 to 30% of the patients. Since antithyroid drug therapy has poor permanent effect and recurrence rates of about 50 to 60% and radioiodine in turn requires higher doses and often repeated application, surgery is to be recommended as the primary treatment of choice for the nodular hyperthyroid goitre. -For Graves' disease the method of therapy is not as clear cut. Operation is indicated mainly when the disease is severe with a larger goitre or in younger age groups (below 40 years) where radioiodine may not be advisable. For preoperative treatment the use of antithyroid drugs in preferred, although iodine perhaps in combination with beta blockers may be used safely as well at least for moderate cases. In the presence of alternative means of treatment surgery should not exceed an operative risk of 0.5-1.5% with virtually no mortality. Our own experiences are based on a retrospective analysis of 702 patients from three hospitals.