Revisiting the role of surgery in the treatment of Graves' disease

Oded Cohen; Ohad Ronen; Avi Khafif; Juan P Rodrigo; Ricard Simo; Pia Pace-Asciak; Gregory Randolph; Lauge H Mikkelsen; Luiz P Kowalski; Kerry D Olsen; Alvaro Sanabria; Ralph P Tufano; Silvia Babighian; Ashok R Shaha; Mark Zafereo; Alfio Ferlito

doi:10.1111/cen.14653

Revisiting the role of surgery in the treatment of Graves' disease

Oded Cohen, Ohad Ronen, Avi Khafif, Juan P Rodrigo, Ricard Simo, Pia Pace-Asciak, Gregory Randolph, Lauge H Mikkelsen, Luiz P Kowalski, Kerry D Olsen, Alvaro Sanabria, Ralph P Tufano, Silvia Babighian, Ashok R Shaha, Mark Zafereo, Alfio Ferlito

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Abstract

Graves' disease (GD) can be managed by antithyroid drugs (ATD), radioactive iodine (RAI) and surgery. Thyroidectomy offers the highest success rates for both primary and persistent disease, yet it is the least recommended or utilized option reaching <1% for primary disease and <25% for persistent disease. Several surveys have found surgery to be the least recommended by endocrinologists worldwide. With the development of remote access thyroidectomies and intraoperative nerve monitoring of the recurrent laryngeal nerve, combined with current knowledge of possible risks associated with RAI or failure of ATDs, revaluation of the benefit to harm ratio of surgery in the treatment of GD is warranted. The aim of this review is to discuss possible reasons for the low proportion of surgery in the treatment of GD, emphasizing an evidence-based approach to the clinicians' preferences for surgical referrals, surgical indications and confronting traditional reasons and concerns relating to the low referral rate with up-to-date data.

Originalsprog	Engelsk
Tidsskrift	Clinical Endocrinology
Vol/bind	96
Udgave nummer	6
Sider (fra-til)	747-757
Antal sider	11
ISSN	0300-0664
DOI	https://doi.org/10.1111/cen.14653
Status	Udgivet - jun. 2022

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10.1111/cen.14653

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Cohen, O., Ronen, O., Khafif, A., Rodrigo, J. P., Simo, R., Pace-Asciak, P., Randolph, G., Mikkelsen, L. H., Kowalski, L. P., Olsen, K. D., Sanabria, A., Tufano, R. P., Babighian, S., Shaha, A. R., Zafereo, M., & Ferlito, A. (2022). Revisiting the role of surgery in the treatment of Graves' disease. Clinical Endocrinology, 96(6), 747-757. https://doi.org/10.1111/cen.14653

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abstract = "Graves' disease (GD) can be managed by antithyroid drugs (ATD), radioactive iodine (RAI) and surgery. Thyroidectomy offers the highest success rates for both primary and persistent disease, yet it is the least recommended or utilized option reaching <1% for primary disease and <25% for persistent disease. Several surveys have found surgery to be the least recommended by endocrinologists worldwide. With the development of remote access thyroidectomies and intraoperative nerve monitoring of the recurrent laryngeal nerve, combined with current knowledge of possible risks associated with RAI or failure of ATDs, revaluation of the benefit to harm ratio of surgery in the treatment of GD is warranted. The aim of this review is to discuss possible reasons for the low proportion of surgery in the treatment of GD, emphasizing an evidence-based approach to the clinicians' preferences for surgical referrals, surgical indications and confronting traditional reasons and concerns relating to the low referral rate with up-to-date data.",

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AU - Randolph, Gregory

AU - Mikkelsen, Lauge H

AU - Kowalski, Luiz P

AU - Olsen, Kerry D

AU - Sanabria, Alvaro

AU - Tufano, Ralph P

AU - Babighian, Silvia

AU - Shaha, Ashok R

AU - Zafereo, Mark

AU - Ferlito, Alfio

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N2 - Graves' disease (GD) can be managed by antithyroid drugs (ATD), radioactive iodine (RAI) and surgery. Thyroidectomy offers the highest success rates for both primary and persistent disease, yet it is the least recommended or utilized option reaching <1% for primary disease and <25% for persistent disease. Several surveys have found surgery to be the least recommended by endocrinologists worldwide. With the development of remote access thyroidectomies and intraoperative nerve monitoring of the recurrent laryngeal nerve, combined with current knowledge of possible risks associated with RAI or failure of ATDs, revaluation of the benefit to harm ratio of surgery in the treatment of GD is warranted. The aim of this review is to discuss possible reasons for the low proportion of surgery in the treatment of GD, emphasizing an evidence-based approach to the clinicians' preferences for surgical referrals, surgical indications and confronting traditional reasons and concerns relating to the low referral rate with up-to-date data.

AB - Graves' disease (GD) can be managed by antithyroid drugs (ATD), radioactive iodine (RAI) and surgery. Thyroidectomy offers the highest success rates for both primary and persistent disease, yet it is the least recommended or utilized option reaching <1% for primary disease and <25% for persistent disease. Several surveys have found surgery to be the least recommended by endocrinologists worldwide. With the development of remote access thyroidectomies and intraoperative nerve monitoring of the recurrent laryngeal nerve, combined with current knowledge of possible risks associated with RAI or failure of ATDs, revaluation of the benefit to harm ratio of surgery in the treatment of GD is warranted. The aim of this review is to discuss possible reasons for the low proportion of surgery in the treatment of GD, emphasizing an evidence-based approach to the clinicians' preferences for surgical referrals, surgical indications and confronting traditional reasons and concerns relating to the low referral rate with up-to-date data.

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KW - Humans

KW - Iodine Radioisotopes/therapeutic use

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Revisiting the role of surgery in the treatment of Graves' disease

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