title: Total thyroidectomy is the preferred treatment for patients with Graves' disease and a thyroid nodule.
abstract: OBJECTIVE
  To identify the indications and outcomes of total thyroidectomy for Graves' disease in a North American cohort.
  
  
  METHODS
  Prospective database of 297 patients undergoing total thyroidectomy in a tertiary care center identified 49 patients with Graves'.
  
  
  RESULTS
  There were 37 women and 12 men (mean age, 37.9 years). Common indications for surgery were: refusal of radioactive iodine (20%), thyroid storm (18%), a thyroid nodule (16%), failure of I131(14%), and ophthalmopathy (14%). Complications included: symptomatic hypocalcemia (14%), permanent hypoparathyroidism (0%), and symptoms of recurrent laryngeal nerve injury (0%). Graves' patients had more bleeding (117 mL versus 48 mL, P<0.05). Clinical nodules were malignant in 38%. Papillary thyroid carcinoma occurred in 10% of patients, with 60% multifocal, and 60% lymph node metastases.
  
  
  CONCLUSIONS
  Total thyroidectomy for Graves' has minimal morbidity. Patients with Graves' and a thyroid nodule are at an increased risk for malignancy and should be treated with a total thyroidectomy.
authors.affiliation: Department of Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Boostrom
authors.forename: Melanie L
authors.initials: ML
authors.lastname: Richards
mesh_terms: D000328:Adult; D002291:Carcinoma, Papillary / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006111:Graves Disease / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D016606:Thyroid Nodule / Q000453:epidemiology / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods