Sarah Oltmann, M.D. Answers Questions On: Hyperthyroidism
When would you recommend surgery for hyperthyroidism?
Based on the most recent ATA guidelines, surgery is one of three equivalent treatment options for patients when they are diagnosed with hyperthyroidism, which occurs when your thyroid makes too much thyroxine. Hyperythyroidism causes sudden weight loss, sweating, tremor, and irregular heartbeat, among other symptoms.
Historically, surgery has been underutilized as a treatment, in part because it’s a tedious operation for surgeons, especially those who don’t do thyroid procedures very often – which can mean increased risk of complication for the patient. But for an experienced, high-volume surgeon, the outcomes can be outstanding, and it provides patients with a clearly definitive treatment and a definitive cure of their hyperthyroidism.
What are the other treatments for hyperthyroidism?
Other treatments include medications to control hormone overproduction. In preparation for surgery, patients will often start this therapy to bring thyroid hormone levels under control so that anesthesia will be safe. However, the anti-thyroid medications have some rare but very serious side effects that make lifelong treatment with them not ideal.
Another treatment option is radioactive iodine. But it’s not a quick cure. While the radioactive iodine is slowly causing destruction of the thyroid tissue, the patient’s hormone levels gradually transition from too high to too low, a process that may take many months to complete. During this time, the patient may experience significant symptoms from this dysregulation. Additionally, patients with hyperthyroidism due to Graves’ disease can have exacerbation of their eye disease. About 30 percent of patients have their hyperthyroidism come back after radioactive iodine treatment, prompting either additional radioactive iodine treatments or surgery.
What can patients expect after surgery for hyperthyroidism?
They can expect immediate resolution of their hyperthyroid symptoms. We start them on thyroid hormone replacement within a day or two of the operation, depending on how well their hyperthyroidism was controlled before surgery.
They never go through that period of hormone fluctuation often experienced with the radioactive iodine treatment. They may have a little bit of swelling after surgery, but that usually resolves and goes down within a few weeks. It’s part of the normal healing process.
The huge benefit is that surgery provides them with immediate control of their hormone overproduction and, at the same time, it does not put them at increased risk to have the problem come back in the future. For patients with Graves’ disease, future problems with activation or exacerbation of eye symptoms is much lower than with radioactive iodine treatments.