Dr.Guttler’s Patient Thyroid Blog Post #16 Miss leading paper of Quality of life after surgery for Graves’ and Toxic nodular goiter.

Dr.Guttler’s Patient Thyroid Blog Post #16  Miss leading paper of Quality of life after surgery for Graves’ and Toxic nodular goiter.

Dr.Guttler’s comments:

  1.  In 2022 surgery and radioiodine are used less often than long term low dose Anti thyroid drugs.

  2. Surgery has it’s own loss of quality of life when complications occur and a scar is left , and life long thyroid replacement therapy is needed.

  3. There is further Qol issues when the surgeon left too much thyroid after the so called “total” that there is a recurrence of hyperthyroidism.

  4. The recurrence can be treated with another surgery with increased risk of complications or RAI/131.  However ATD long term is the safe way to go.

  5. Radioiodine also has QoL issues after the treatment including cancer risks, salivary gland damage, and life long thyroid hormone therapy.

  6. Most patients opt for ATD therapy long term if no remission occurs.

  7. Both RAI/131 and surgery require total ablation of the thyroid to prevent recurrence.

  8. The thyroid hormone therapy after surgery or RAI/ adds a new level of QoL issues.

  9. Long term management of hypothyroidism requires blood tests to monitor the dosing. Excessive hormone leads to hyperthyroidism. Inadequate dosing leads to hypothyroidism.

  10. After rash, the other complications from ATD therapy. are extremely rare.

  11. ATD therapy needs dosing as well but if the tests are normal on ATD there is no need for Thyroid hormone therapy.

  12. As for toxic nodule or AFTN, the use of Radiofrequency RFA can ablate the toxic nodule and leave the rest of the thyroid intact leaving no need for thyroid hormone replacement.

  13. Call me at 310-393-8860 or email to thyroid.manager@thyroid.com

  14. Ask for Alicia

  15. Dr.G.

Improved quality of life in hyperthyroidism patients after surgery

https://doi.org/10.1016/j.jss.2014.07.061Get rights and content



The most common causes of hyperthyroidism are Graves disease (GD) and toxic nodular goiter (TNG). GD and TNG might influence patients’ quality of life (QoL). The aim of our study was to analyze and compare the QoL of patients with GD with that of TNG patients and to evaluate the influence of surgical treatment on their QoL.

Materials and methods

A prospective case-control study was conducted at the Center for Endocrine surgery in Belgrade, Serbia. The ThyPRO questionnaire was used in the QoL assessment of the GD and TNG patients (31 and 28, respectively) pre- and post-operatively.


All patients were receiving antithyroid drugs, and none of the patients were overtly hyperthyroid at the time of completing the preoperative questionnaire. The QoL of the GD patients was worse than that of the TNG patients, with significant differences in eye symptoms, anxiety, and sex life domains (P < 0.001, P = 0.005, and P = 0.004, respectively), preoperatively, and in eye symptoms, anxiety, emotional susceptibility, and overall QoL (P = 0.001, P = 0.027, P = 0.005 and P = 0.013, respectively), postoperatively. The improvement in QoL in the GD patients was significant after surgical treatment in all ThyPRO domains. In the TNG patients, the improvement was significant in all but one ThyPRO domain, sex life (P = 0.066).


The QoL of GD patients is worse than those of TNG patients. Surgery may improve QoL in patients with GD and TNG even if they have achieved satisfying thyroid status with medication treatment, preoperatively.

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