Graves' ophthalmopathy: The case for thyroid surgery

Graves' disease is the most common cause of hyperthyroidism and is frequently complicated by ophthalmopathy, which can be a debilitating component of the disease, resulting in impaired quality of life. The management of Graves' disease aims to restore the patient to a euthyroid state and minimise the extent of extrathyroidal manifestations such as ophthalmopathy. Management options include medical therapy, radioactive iodine (RAI) and surgical intervention in the form of thyroid resection. Graves' ophthalmopathy (GO) is often resistant to or even aggravated by medical therapy and RAI, both of which have unpredictable relapse rates. The extent of thyroidectomy in the management of benign thyroid disease remains controversial. Total thyroidectomy is being increasingly favoured as the procedure of choice for treatment of benign thyroid disease. Recent study has indicated that it can be performed with minimal complications at a rate comparable to the less radical subtotal thyroidectomy. The predictable outcome and lack of disease recurrence make it an attractive option for benign conditions such as Graves' disease. In addition, there is increasing evidence that total thyroidectomy may have a beneficial effect, inducing an improvement in eye signs and symptoms in cases of GO. This review discusses the indications for surgical intervention in Graves' disease, with specific focus on the extent of resection and the relative merits of subtotal and total thyroidectomy in patients with GO.