A 45-year-old man with Graves' disease and moderate-to-severe Graves' orbitopathy is being considered for definitive treatment. Which surgical approach is recommended?

• A Subtotal thyroidectomy preserving posterior thyroid tissue
• B Total thyroidectomy with routine prophylactic central neck dissection
• C Hemithyroidectomy with subtotal resection of the contralateral lobe
• D Near-total or total thyroidectomy ✓

Explanation

Total or near-total thyroidectomy is the surgical treatment of choice for Graves' disease. It removes the source of thyroid antigen that drives the autoimmune process and reduces recurrence risk. Subtotal thyroidectomy leaves residual tissue that may perpetuate orbitopathy and carries a higher recurrence rate. Prophylactic neck dissection is not indicated in Graves' disease.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

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Written and medically reviewed by the StethoPrep medical team.