Surgery for Thyrotoxicosis

N. Perrier, O. Clark, S. Fisher
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Abstract

Antithyroid medications, radioactive iodine, or thyroidectomy are viable therapeutic options for the patient with thyrotoxicosis, with relative pros and cons for each modality varying with patient comorbidities and preferences, and the expertise of the treating physicians. Of the three modalities, surgery is the most invasive but also the most definitive, and is favoured for patients with symptomatic compression, concomitant documented/suspected malignancy, or coexisting hyperparathyroidism requiring surgical intervention. Thyroidectomy for treatment of thyrotoxicosis is also advantageous for women who are pregnant, lactating, or planning pregnancy, for patients with moderate to severe Graves’ orbitopathy, or when immediate control of symptoms is necessary. In experienced hands, thyroidectomy is performed with minimal morbidity and should be considered in the patient who places more relative emphasis on prompt and definitive control of symptoms with avoidance of radioactive therapy and/or medications, with less concerns regarding operative risks and/or need for lifelong thyroid hormone replacement.
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甲状腺毒症的手术治疗
抗甲状腺药物、放射性碘或甲状腺切除术是甲状腺毒症患者可行的治疗选择,每种治疗方式的利弊因患者合并症和偏好以及治疗医生的专业知识而异。在这三种治疗方式中,手术是最具侵入性的,但也是最明确的,适用于有症状压迫、合并有记录的/怀疑的恶性肿瘤或合并甲状旁腺功能亢进需要手术干预的患者。甲状腺切除术治疗甲状腺毒症也有利于孕妇、哺乳期妇女或计划怀孕的妇女、中度至重度Graves眼病患者或需要立即控制症状的患者。在经验丰富的医生中,甲状腺切除术的发病率最低,对于那些相对更强调及时和明确控制症状、避免放射治疗和/或药物治疗、较少关注手术风险和/或需要终身更换甲状腺激素的患者,应考虑甲状腺切除术。
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