**6.3 Surgical treatment**

Surgical treatment of Graves' Disease is the oldest therapeutic method and total thyroidectomy which prevents relapse of hyperthyroidism is currently recommended. However, it is burdened with the risk of retrograde laryngeal nerve injury, hypoparathyroidism and more seldom hypothyroidism relapse (referring to 1–5% of children after total thyroidectomy vs. approximately 10–20% after partial or subtotal thyroidectomy). Sporadically, infection or keloid is observed at the site of the postoperative scar. The risk of complications depends to a large extent on the skills and experience of a surgeon. Importantly, prior to surgery a patient has to be treated with a thyrostatic drug and be in euthyreosis, receive iodide preparations (e.g. Lugol's solution or potassium iodide) 7–10 days before, 3–7 drops, each dose twice daily to reduce thyroid gland vascularity.

## **6.4 Excision of thyroid tissue**

In rare cases of hyperthyroidism in children that is caused by the presence of autonomic tissue, radical treatment with thyroid removal or administration of ablation doses of radioiodine is recommended. In the state of thyroid hormone poisoning, the hormones need to be withdrawn and a -adrenolitic drug, e.g. propranolol, should be administered.

The therapy should be individually tailored and discussed both with the patient and the family [23–26].
