Graves disease is caused by an antibody made by the body's own immune system which attacks the eyes and thyroid gland.
In the thyroid gland the result is overproduction of thyroid hormone.
The treatment is to bring the thyroid under control with anti-thyroid medication. These drugs have significant side effects and there is a risk of agranulocytosis (loss of all white blood cells) which means patients cant fight infection and can become very ill.
Drugs usually work well and after a year if all is controlled they can be stopped and many patients will be cured. For those where the disease relapses it is essential to restart the drugs and seek a definitive treatment.
There are two definitive treatments:
1. Radioactive iodine
2. Total thyroidectomy
I wont discuss radio-iodine here but it is good for small thyroids and patients without eye problems.
Surgery should always be a total thyroidectomy. Some surgeons still offer a sub-total thyroidectomy which is a poor operation.
Sub-total surgery leaves bits of the thyroid behind and this means the tissue can regrow and the disease come back - a crazy situation when it could all be taken away at the first operation.
Surgery is a good option for many people and is offered along the lines of minimal access thyroid surgery.
www.bucksendocrine.com
www.thyroidsurgeon.org.uk
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