Key result
Thyroidectomy effectively eradicates hyperthyroidism in Graves' disease with few complications when performed by high-volume surgeons.
Thyroidectomy is a safe and effective treatment for Graves' disease when performed by high-volume surgeons, and may prevent cardiovascular complications in high-risk patients.
Supports referral to high-volume surgeons for Graves' thyroidectomy; leaves open comparative long-term outcomes versus other modalities.
INTRODUCTION: Graves' disease (GD) is a systemic autoimmune disorder, ultimately caused by autoantibodies stimulating the TSH receptor (TSHR-Ab) on thyroid follicular cells. Novel targeted therapies are under investigation, but treatment of GD still relies on antithyroid drugs (ATDs), radioactive iodine, or thyroidectomy. AREAS COVERED: Narrative review of original articles, randomized clinical trials, systematic reviews and meta-analyses, guidelines on PubMed from inception to March 2026, using the following terms: GD, management of GD, thyroidectomy, hypoparathyroidism, hypocalcemia, recurrent laryngeal nerve injury, hematoma, near-infrared autofluorescence, indocyanine green angiography, Graves' orbitopathy, thyroid eye disease. EXPERT OPINION: Thyroidectomy is the least common treatment for GD. However, it effectively eradicates hyperthyroidism, if all thyroid tissue is removed. Preoperative preparation includes ATD treatment to restore euthyroidism whenever possible, iodine solution (controversial in patients rendered euthyroid prior to surgery), and vitamin D (with or without calcium), if deficient. In patients with risk factors for cardiovascular (CV) complications, thyroidectomy may prevent the CV risk associated with unstable/severe hyperthyroidism. Thyroidectomy is safe in the hands of skilled, high-volume surgeons, with a low incidence of the main complications, i.e. hypoparathyroidism, recurrent laryngeal nerve injury, and hematoma.
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Bartalena et al. (2026) conducted a review in Graves' disease. Thyroidectomy was evaluated. Thyroidectomy effectively eradicates hyperthyroidism in Graves' disease and is safe when performed by skilled, high-volume surgeons, with a low incidence of complications.
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