Graves’ disease is a cause of an overactive thyroid and may require surgery.
Graves’ disease is an ‘autoimmune’ disease which means that the cause is the body’s own immune process attacking the thyroid in error. Fortunately, for most people, the disease settles down of its own accord within a year with medicines such as carbimazole or propylthiouracil. For some people, the disease does not settle after medical treatment or it recurs. If this happens then definitive treatment is required, the options being removal of the whole thyroid or radioactive iodine.
Your endocrinologist will have a discussion with you about whether radioactive iodine or surgery is likely to suit you best. In general, surgery is a more suitable option when there are reasons to avoid radioactive iodine. These include, patients with severe or active Graves’ eye disease (which may be worsened by radioiodine), women who are pregnant, breastfeeding, or wish to become pregnant within the next 6 months and anyone who lives or works with young children and cannot be apart from them.
If surgery is chosen you will meet with your surgical team in clinic to discuss what this involves and what the risks are.
Before surgery you may be asked to prepare by
Taking potassium iodide tablets (these are taken for the 10 days leading up to surgery and help to block thyroid activity to make surgery safer. Do not take these if you are allergic to iodine)
Topping up your vitamin D level with tablets (this helps prevent low calcium levels being difficult to manage after surgery)
In this condition, the thyroid gland contains multiple nodules that are usually benign (non-cancerous). These may cause enlargement or distortion of the thyroid gland which in turn can put pressure on the surrounding structures in the neck (the voice box, windpipe and gullet) resulting in changes in breathing and swallowing. If these ‘compressive’ symptoms occur then you may be offered surgery to improve them.
The surgery is tailored to the part of your thyroid gland is affected and may be a hemithyroidectomy (removal of half the thyroid) or total thyroidectomy, depending on which part.
Your goitre may extend down from your neck into your chest. This is called a ‘retrosternal goitre’. At the Hammersmith Endocrine Surgery we specialise in removing these large and complex goitres and on the rare occasions in which it is not possible to remove the goitre safely from the neck alone, your surgeon will be joined by a specialist cardiothoracic surgical colleague to open the breast bone partially or fully (manubrial split / sternotomy).
Most thyroid nodules are benign (non-cancerous) however around 5% are cancerous and in a further 20%, it is not possible to obtain a definite diagnosis with a biopsy (these are called ‘indeterminate’ nodules). Surgery is required in both of these situations either to treat and/or diagnose thyroid cancer.
Thyroid nodules with these biopsy results have an approximately 25% chance of being cancerous. Further biopsies do not usually assist with making a diagnosis and so surgery to remove the nodule within the thyroid lobe is required to make a diagnosis and, in many cases, is the only treatment required.
If you have this biopsy result at Hammersmith Endocrine Surgery, you will be advised to have a hemithyroidectomy. The thyroid tissue which has been removed will then be analysed under the microscope (‘histology’) by a specialist thyroid pathologist and reviewed in our MDT meeting which takes around 2 weeks. If the tumour is a cancer with aggressive features then you will be advised to have further surgery to remove the rest of the thyroid gland (‘completion thyroidectomy’) to permit radioactive iodine treatment.
At Hammersmith Endocrine Surgery we specialise in the diagnosis and treatment of all types of thyroid cancer from the more common papillary and follicular tumours to rare tumours such as medullary and anaplastic cancers.
If your biopsy result confirms a thyroid cancer, you will have a meeting with your surgical team and one of our cancer specialist nurses will contact you.
You will be advised as to what surgery you require, ranging from removing half of the thyroid (hemithyroidectomy) for a microcarcinoma (cancer less than 10mm) to removing all of the thyroid (total thyroidectomy) with/without removal of the lymph glands (lymph node dissection).