Surgery is the least common treatment recommended for Graves' disease. Similar to radioiodine therapy, it is a permanent treatment. However, there are greater relative risks compared to medicines and radioiodine therapy.
For example, the parathyroid glands could be damaged because they are located close to the thyroid gland. Parathyroid glands help control calcium levels in the body. Damage to the laryngeal nerve, also located close to the thyroid gland, could lead to voice changes or breathing problems. When surgery is performed by an experienced surgeon, however, less than 1 percent of people have permanent complications.
Treatment for Graves' Ophthalmopathy
The classic "triad of Graves' disease" is hyperthyroidism, Graves' ophthalmopathy, and pretibial myxedema. If a person with Graves' disease has both hyperthyroidism and Graves' ophthalmopathy, the treatment choices are more complex.
Healthcare providers will consider a number of different factors, including the severity of the eye symptoms, before recommending treatment to deal with both the hyperthyroidism and ophthalmopathy.
For mild eye symptoms, eye shades or artificial tears may be helpful and the only treatment needed. In other cases, artificial tears during the day and eye lubricants at night might provide relief of symptoms.
For people with more severe symptoms, oral steroids such as prednisone may be prescribed. People often see improvement after about four weeks of this therapy. Treatment is usually continued for at least six months.
Other options that may be recommended to treat moderate-to-severe Graves' ophthalmopathy include external orbital radiation or surgery.
Treating Pretibial Myxedema
Pretibial myxedema occurs in no more than 5 percent of people with Graves' disease, and most people with pretibial myxedema do not seek treatment because the problem does not bother them. For people who do have bothersome symptoms, a steroid ointment may be prescribed. If this does not heal the skin, a steroid given by mouth may be necessary. About one-half of people have moderate to complete remission following treatment.
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