الفهرس 
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Abstract
Graves’ disease is an autoimmune disease that causes the thyroid to overproduce and over-secrete thyroid hormones. This results in hyperthyroidism and can cause a wide variety of symptoms to occur. Graves’ disease is the most common form of hyperthyroidism, also known as toxic diffuse goiter, Suppressed TSH in the face of an elevated free thyroxine (FT4) level, Signs and symptoms of hyper-thyroidism may include irritability, muscle weakness, sleeping problems, a fast heartbeat, poor tolerance of heat, diarrhea, and weight loss. Other symptoms may include thickening of the skin on the shins, known as pretibial myxedema, and eye bulging, a condition caused by Graves’ ophthalmopathy. Thyroid-stimulating hormone (TSH, usually undetectable in Graves’ disease due to negative feedback from the elevated T3 and T4).
Three treatment modalities are available for the treatment of hyper-thyroidism: antithyroid medication, radioiodine therapy, and surgery.
Treatment involves alleviation of symptoms and correction of the thyrotoxic state. Adrenergic hyperfunction is treated with beta-adrenergic blockade. Correcting the high thyroid hormone levels can be achieved with antithyroid medications that block the synthesis of thyroid hormones or by treatment with radioactive iodine. The goals of treatment of Graves’ disease are to control symptoms efficiently and restore euthyroidism. Antithyroid drugs, radioiodine and surgery all effectively restore euthyroidism but have potentially serious side effects. Surgery is a treatment option for hyperthyroidism. Thyroid surgery is known as a thyroidectomy and involves the partial or total removal of the thyroid gland.
Total Thyroidectomy, this operation is designed to remove all of the thyroid gland. Subtotal Thyroidectomy in which the surgeon leaves a small thyroid remnant in situ to preserve thyroid function. Subtotal thyroidectomy as a surgical option has been superseded as it leads to unacceptable results in 30% of patients. Because it is impossible in the individual case to know exactly how much thyroid tissue to leave behind the recurrence rate of thyrotoxicosis is 8-25%, and approximately 30-50% develop hypothyroidism after subtotal thyroidectomy. In experienced hands there is no difference in complication rates when a total thyroidectomy is performed, and patients have certainty about their thyroid status.
While subtotal thyroidectomy is generally satisfactory in most cases, the only operation that eliminates the risk of recurrence is total thyroidectomy. Although this operation virtually eliminates this risk, it comes at the cost of needing life-long thyroid hormone replacement, so patients need to be aware that this is inevitable. Some patients are against taking thyroxine however, despite the risks of recurrence, in which case subtotal thyroidectomy should be performed, leaving approximately 4-8 mls of thyroid tissue behind.
Hypocalcaemia (low calcium) is very common after surgery for thyrotoxicosis, as it is a condition which tends to deplete calcium in the bones over the long term. Hungry bone syndrome is not uncommon, so that calcium should be monitored closely in the postoperative period. Any calcium DROP tends to be temporary however, and returns to normal after a few weeks to months of replacement therapy.