Surgical considerations for adult Graves' disease: a narrative review of indications, perioperative challenges and postoperative outcomes.

IF 2.9 Q3 ENDOCRINOLOGY & METABOLISM

Expert Review of Endocrinology & Metabolism Pub Date : 2026-07-01 Epub Date: 2026-05-21 DOI:10.1080/17446651.2026.2676876

Luigi Bartalena, Daniela Gallo, Eliana Piantanida, Maria Laura Tanda

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引用次数: 0

Abstract

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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成人格雷夫斯病的手术考虑：适应症、围手术期挑战和术后结果的叙述性回顾。

格雷夫斯病（GD）是一种全身性自身免疫性疾病，最终由自身抗体刺激甲状腺滤泡细胞上的TSH受体（TSHR-Ab）引起。新的靶向治疗方法正在研究中，但GD的治疗仍然依赖于抗甲状腺药物（ATDs）、放射性碘或甲状腺切除术。涵盖的领域：原始文章的综述、随机临床试验、系统评价和荟萃分析、PubMed从初始到2026年3月的指南，使用以下术语：GD、GD的治疗、甲状腺切除术、甲状旁腺功能减退症、低钙血症、喉复发神经损伤、血肿、近红外自身荧光、茚多酚绿血管造影、Graves眼病、甲状腺眼病。专家意见：甲状腺切除术是GD最不常用的治疗方法。然而，它有效地根除甲状腺机能亢进，如果所有的甲状腺组织被切除。术前准备包括ATD治疗以尽可能恢复甲状腺功能正常，碘溶液（在手术前甲状腺功能正常的患者有争议），如果缺乏维生素D（含或不含钙）。在有心血管（CV）并发症危险因素的患者中，甲状腺切除术可以预防与不稳定/严重甲状腺功能亢进相关的CV风险。甲状腺切除术在熟练的大容量外科医生手中是安全的，主要并发症，如甲状旁腺功能低下、喉返神经损伤和血肿的发生率低。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Expert Review of Endocrinology & Metabolism ENDOCRINOLOGY & METABOLISM-

CiteScore

4.80

自引率

0.00%

发文量

期刊介绍： Implicated in a plethora of regulatory dysfunctions involving growth and development, metabolism, electrolyte balances and reproduction, endocrine disruption is one of the highest priority research topics in the world. As a result, we are now in a position to better detect, characterize and overcome the damage mediated by adverse interaction with the endocrine system. Expert Review of Endocrinology and Metabolism (ISSN 1744-6651), provides extensive coverage of state-of-the-art research and clinical advancements in the field of endocrine control and metabolism, with a focus on screening, prevention, diagnostics, existing and novel therapeutics, as well as related molecular genetics, pathophysiology and epidemiology.