Selection of patients for surgery in the management of thyrotoxicosis

There is at present no consensus as to what the best treatment for thyrotoxicosis is. If the patients are carefully selected, surgery offers a safe and effective cure for the disease over a short period of time. We reviewed the selection criteria of forty-one patients with thyrotoxicosis treated surgically in Alexandra Hospital. Over 90% of the patients were referred for surgery by physicians and general practitioners. The majority (95%) were young patients (under 40 years) and almost all were treated with antithyroid drugs before opting for surgery. The most common indication given for surgery was failure of conservative treatment (20/41). This was followed by patients who had difficulty adhering to the antithyroid drug regime (12/41) and patients who requested surgery for cosmetic reasons (5/41). Almost half of the patients had large glands (> 50g). One year after surgery, 84% of the patients remained euthyroid, 8% developed hypothyroidism and 8% had relapsed thyrotoxicosis. Three quarters of the patients tested positive for thyroid antibodies. This did not appear to increase the rate of hypofunction. There was no mortality from surgery.