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

Research output: Contribution to journalReview articlepeer-review

9 Scopus citations


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.

Original languageEnglish
Pages (from-to)747-757
Number of pages11
JournalClinical Endocrinology
Issue number6
StatePublished - Jun 2022

Bibliographical note

Publisher Copyright:
© 2021 John Wiley & Sons Ltd.


  • Graves' disease
  • head and neck
  • hyperthyroidism
  • surgery


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