When is surgery indicated as a treatment for Graves disease?
In many centers, particularly in Europe, surgery is a common first line treatment for Graves’ disease. In North America, radioactive iodine and medications tend to be used more than surgery. Patients who are pregnant and have medication allergies, patients with extremely large thyroid glands, and patients with one or more thyroid nodules and Graves’ disease often represent reasonable surgical candidates. The risk of thyroid cancer developing in a cold nodule in Graves’ disease is ~ the same risk as in patients without Graves’ disease, namely about 15%. To review a study of this issue, see Multicentre study of thyroid nodules in patients with Graves’ disease. Br J Surg. 2000 Aug;87(8):1111-3.
