**6. Indications for surgery**

Surgery is the treatment of choice in those with compressive symptoms attributable to goiter, large goiters, presence/suspicion of co-existing malignancy, GD with non-malignant nodule with no/reduced uptake of RAI which is large in size, co-existing parathyroid pathology. Those lactating, pregnant or desirous of pregnancy within next 6 months and presence of significant active ophthalmopathy are advised surgery [5, 18–20]. Pediatric patients failing ATD are more likely to undergo thyroidectomy compared to RAI [21]. Intolerance/non-compliance to ATD, patient preference is an indication in themselves for surgery as treatment of choice.

Indications of thyroidectomy in GD patients include following (6C's):

