Surgery for Graves disease, which was once widely practiced in North America, has become rather uncommon. Because even women of child-bearing age and children are often treated with radioiodine, the current indications for thyroidectomy in Graves disease are limited to the following: patients who have failed antithyroid drug or radioiodine treatment, those who require a rapid and definitive reversal of hyperthyroidism (eg, during pregnancy), or those who have an aversion to irradiation. Finally, thyroidectomy should be used in patients who have Graves disease with a concomitant thyroid nodule that should be removed to rule out a potential malignancy. The shift to radioiodine therapy has occurred because it is less expensive, less invasive, and relatively safe: avoiding the main surgical complications of hyperparathyroidism and recurrent laryngeal nerve injury. Clearly, Huang et al have experience in treating Graves disease that is unmatched by any endocrine surgeon in North America. The ability of Huang and coworkers to amass 52 patients in a 7-month period indicates a major philosophical difference in the management of Graves disease in Asia.
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