title: Should the primary treatment of hyperthyroidism be surgical?
abstract: OBJECTIVE
  To review the results of the surgical treatment of all types of hyperthyroidism (Graves' disease, toxic nodular goitre, and toxic solitary adenoma).
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University hospital and private hospital, Greece.
  
  
  METHODS
  400 Consecutive patients who were operated on between 1982 and 1991.
  
  
  METHODS
  Near total/total thyroidectomy in 226 patients with toxic nodular goitre and 87 patients with Graves' disease. Subtotal thyroidectomy in 25 patients with Graves' disease (early period of the study); lobectomy with resection of the isthmus of the thyroid in 62 patients with a solitary toxic adenoma.
  
  
  METHODS
  Mortality, morbidity and patients' self assessment of the results of operation (symptoms, scar, ophthalmopathy).
  
  
  RESULTS
  There was no mortality. Morbidity included 2 postoperative bleeds that required reoperation; 2 patients developed permanent unilateral vocal cord paralysis and 2 had permanent hypoparathyroidism. In 27 of the 400 patients (7%) a thyroid carcinoma was found in the resected specimen. No patient had persistent or recurrent hyperthyroidism 2 to 10 years after operation. Of the 49 patients with Graves' disease and opthalmopathy at the time of operation, 35 (71%) reported improvement in their ophthalmopathy and 14 (29%) reported no improvement. No patient had worsening of their exophthalmos; 388 (97%) were satisfied with their incision; and 360 (90%) reported a significant improvement in their preoperative symptoms (tachycardia, weakness, anxiety, and pressure in the neck).
  
  
  CONCLUSIONS
  We suggest that the primary treatment of all types of hyperthyroidism should be surgical.
authors.affiliation: Department of Surgery, Athens Medical School, Greece.
authors.forename: D A
authors.initials: DA
authors.lastname: Linos
authors.forename: D
authors.initials: D
authors.lastname: Karakitsos
authors.forename: J
authors.initials: J
authors.lastname: Papademetriou
mesh_terms: D000328:Adult; D005094:Exophthalmos / Q000209:etiology; D005260:Female; D006111:Graves Disease / Q000601:surgery; D006801:Humans; D006980:Hyperthyroidism / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000150:complications; D016606:Thyroid Nodule / Q000601:surgery; D013965:Thyroidectomy; D016896:Treatment Outcome