• By Liza Torborg

Tuesday Q and A: Several treatment options decrease symptoms of Graves’ disease

September 16, 2014

Thyroid glandDEAR MAYO CLINIC: Three months ago I was diagnosed with Graves’ disease. I have decided to have a thyroidectomy and want to know what to expect after the procedure. Will all of my symptoms (Graves’ ophthalmopathy, heart palpitations, irritability) go away immediately after surgery? What are the side effects of having the thyroid removed?

ANSWER: Thyroid removal is one of several treatment options that can effectively decrease symptoms of Graves’ disease. Others include anti-thyroid medications and radioiodine. Each person is different, and no one treatment is best for everyone. A thyroidectomy often relieves symptoms of Graves’ disease. But as with all surgery, there are risks and possible complications associated with thyroidectomy.

Graves’ disease is an immune system disorder that results in the overproduction of thyroid hormones, a condition known as hyperthyroidism. Because thyroid hormones affect many of your body’s functions, signs and symptoms of Graves’ disease can be wide ranging.

Medications that interfere with the thyroid’s use of iodine to produce hormones, known as anti-thyroid medications, may be helpful in controlling the disease. These prescription medications include propylthiouracil and methimazole.

More often, however, the disease is treated with radioactive iodine therapy, also called radioiodine. Because the thyroid needs iodine to produce hormones, the radioiodine goes into the thyroid cells. The radioactivity destroys the overactive thyroid cells over time. This causes your thyroid gland to shrink. Symptoms lessen gradually, usually over several weeks to several months.

Treating Graves’ disease with a thyroidectomy involves removing all or nearly all of the thyroid gland. The main side effect of not having a thyroid is the need for ongoing thyroid medication — usually one pill a day. Treatment with radioiodine also results in a need for life-long thyroid medication.

People with Graves’ disease who have ophthalmopathy — a condition characterized by bulging eyes, swollen or retracted eyelids, and eye redness — may chose surgery to remove the thyroid over radioiodine because the inflammation that causes those eye symptoms can get worse with radioiodine. Ophthalmopathy usually improves after surgery. But in some people, the symptoms may never go away completely. It can take several months to see the full effects of surgery on ophthalmopathy.

Typically, heart palpitations fade after thyroidectomy. It may take about a week for them to disappear. Irritability related to the Graves’ disease should improve after surgery as well.

Other reasons you may want a thyroidectomy or why it may be recommended as the best treatment include: a very large thyroid gland, suspicious thyroid nodules, failure or fear of radioiodine, or inability to take anti-thyroid medications. In addition, symptoms tend to go away faster with surgery than with other therapies.

Surgery also may be a good choice if you want to become pregnant in the near future, as some of the other treatments can increase the risk of birth defects.

Although they are small, there are risks associated with thyroidectomy. There could be permanent injury to the parathyroid glands. They are located next to the thyroid and regulate calcium. This type of injury would create a permanent need for calcium and vitamin D supplements.

The risk of injury during surgery to nerves that lead to the voice box is also very rare, but it could result in hoarseness, voice changes or swallowing problems. Severe nerve damage that requires a tracheostomy — a surgically created hole through the front of your neck and into your windpipe to provide an air passage to help you breathe — would be exceedingly rare. In most cases, nerve problems that happen as a result of thyroidectomy get better over time.

Not having a thyroid will not interfere with your day-to-day life as long as you are getting the right dose of thyroid medication. For most people, that is not difficult.

As you make a decision about thyroid surgery, thoroughly review with your doctor all the treatment options, along with their risks and benefits. This will help ensure you make the best choice for your situation. Melanie Richards, M.D., Surgery, Mayo Clinic, Rochester, Minn.

Can you please share the details of shuttle travel between the support center(s)? I normally ride a commuter to work. There have been job postings for positions at the support center and I didn't apply because I thought I would have to drive to work. My only experience has been parking at Walmart North and then riding a shuttle to Harwick. —-Thank you

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Information for the shuttle to the NW Clinic and Support Center is on the Parking & Transportation page: http://mayoweb.mayo.edu/parking/NWshuttle.html

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@Lori, If you are commuting at typical business hours, you would probably have to continue parking at Walmart, riding the park-and-ride downtown, and hop a shuttle (or 2, depending) back up to the support center. Some employees who work at these other loc

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@Samantha: Thank you for the information. It appears you are a staff member outside of Parking and Transportation, correct? If so, and if there is an employee of this department reading this, do you have any other information? I ride a Rochester City Lin

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Oopps! Sorry, thank you Melissa! I read yours after I replied to Samantha.

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I did review the northwest shuttle schedules. There is no mention of travel to the drop off/pick up areas in town (St. Marys & Harwick). Pick up at Mayo Building or any other location in town…? So the northwest shuttle does not come into town, correct? Thank you.

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Lori: Please contact Parking and Transportation at 507-284-8513 to discuss options and schedules. Thank you, your Parking and Transportation team.

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Could you please direct the bus drivers to wait until people are seated before driving off? Twice now the bus has taken off while I am walking to a seat. Yesterday I lost my balance and almost fell. This is not safe for employees! Thank you

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Is there anyway this can be directed to the buses that commute out of town. Nothing is worse having a person talk so loud on her phone I do not need to hear there conversations. Also they do need to move over as well. Thanks

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As to point #3 Don't make your own stop, The drivers need to quit allowing it. I still, almost daily, see the drivers of the east and west shuttle lots stop in the middle of the road and open the door for people in the afternoons.

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The WiFi that was installed on the NW shuttles has never worked. In fact, it will generally just slow down your mobile device. Can it be truly fixed or just removed from the shuttles?

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I have heard of many reports of a certain shuttle driver that drived from the west lot. He drive aggressive and angry and this week even has put others on the road in danger. Is anything being done about this. I hope it isn't our patients he is honking at and reving his engine to. That is not the image Mayo should be putting out on the road. Wanted to report it elsewhere but there seems to be no place on the transportation web page to report such actions.

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Linda, please contact the Card Access Office at parking@mayo.edu with the date/time that this was observed. Parking will then contact First Student, the vendor with the specifics. Thank you, Michelle McDermott,General Service.

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@Lori If your work location was changed to the Support Center, you would likely be granted parking at that location. When I was moved from downtown, I got parking at the Mayo Support Center, even though I wouldn't have qualified for downtown parking

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It is unfortunate that additional stops cannot be added to already existing routes. The Archive building is on the Red/Grey route (although drivers often alter the route) and would warrent "on call" service as much as the Technology and Valleyhigh buildings. As winter approaches icy streets and sidewalks between here and downtown make walking less of a viable option.

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