Should thyroid surgery be the treatment of choice for thyrotoxic parents with young children?
A Falinska, K Ahmed
West Middlesex University Hospital
Introduction: Thyrotoxic Graves` disease is more prevalent in young adults mostly under 40 years of age. Most potential parents and parents with young children are in this group. Currently there are three well-established treatment options for hyperthyroid Grave’s disease: (1) blocking of hormone synthesis by antithyroid drugs; (2) ablation of the thyroid by radioactive iodine; and (3) partial or total surgical removal of the thyroid. Selection of therapy depends on the features of disease (e.g. presence of opthalmopathy) and the characteristics of the patient (e.g. pregnancy and breastfeeding). All three methods provide satisfactory outcomes. Radioiodine may be administered as first-line treatment, or may be given if treatment with an antithyroid drug has failed to result in long-term remission. Thyroidectomy is infrequently recommended for patients with Graves' disease.
Case history: One male and two female patients were seen in the last 4 months in the endocrinology clinic with re-current Graves` disease. They all had children below five years of age for whom they were the only carers. Additionally one of female patients wanted to get pregnant in the next six months. During consultation it became apparent that radioactive iodine is not a suitable option for those patients due to childcare commitments. They were all referred to the thyroid surgeon for consideration of surgery.
Although radioactive iodine is the treatment of choice in re-current Graves disease it has important limitation for people looking after children or planning to have children in the nearest future (up to 28 days restriction on close contact with children under the age of 5 years and avoidance of pregnancy for 4 months following the treatment). Thyroid surgery has achieves euthyroid state promptly but is not free of risk. The risk of the damage to the recurrent laryngeal nerve and/or parathyroid glands is associated with significant postoperative morbidity. As surgical techniques advance and the procedure carries less risk of side effects, it is arguably becoming a desirable therapy intervention for parents with young children.