1st order
- Subtotal thyroidectomy – removal of the main part of the thyroid gland. Indications: in case of large thyroid gland (large strumen), suspected malignant (malignant) change of thyroid gland or personal refusal of radioiodine therapy. Furthermore, surgery is considered if symptoms do not improve or recurrence occurs after therapy with thyrostatic drugs.
- Total thyroidectomy (removal of the entire thyroid gland): this is superior to subtotal surgery provided that the thyroxine supply is ensured (fewer hyperthyroidism recurrences / recurrence of hyperthyroidism).
2nd order
- Orbital decompression – surgical intervention aimed at intraorbital pressure relief and/or proptosis reduction due to endocrine orbitopathy (EO, disease in which there is exophthalmos (protrusion of the eyeballs)). Indications: primarily functional in case of manifest or threatening visual deterioration (worsening of vision) and retrobulbar pressure sensation or for aesthetic reasons in case of disfiguring exophthalmos (protruding eyes). (Ultima Ratio Therapy)
Further notes
- Patients with Graves’ disease and mild to severe endocrine orbitopathy have significant improvement in ocular outcome after thyroidectomy followed by radioiodine elimination of the residual thyroid gland compared with the group of patients with thyroidectomy without radioiodine therapy (surgery plus radioiodine therapy: 75% versus 30% in the surgery group).
- Because children and adolescents do not achieve permanent remission (temporary or permanent remission of disease symptoms) in 50% of cases under thyrostatic therapy (inhibition of the thyroid gland, i.e., hormone production), they must be given the following definitive therapy in the long term:
- Complete surgical thyroidectomy or
- Thyroid ablative radioiodine therapy (nuclear medicine procedure designed to remove or deactivate thyroid tissue).