**7. Advantages of surgery**

Surgery is considered the most effective treatment for GD. It results in prompt control of hyperthyroidism. Co-existing thyroid nodules a subset of which may be harboring malignancy are treated concurrently by surgery [22]. Surgery is said to have the best ophthalmological outcome in ophthalmopathy compared to ATD and RAI although these observations are based on expert opinion or non-randomized clinical trials [23–27]. Recurrence has been seen both after ATD and RAI with the former having a significantly higher recurrence rate. Though the recurrence rates after RAI and surgery are not significantly different, multiple doses of RAI may be required for cure in a given patient [23]. In a meta-analysis involving 1402 patients across 5 continents, surgery had the lowest recurrence rates even though a sub total thyroidectomy was the procedure performed in those with available surgical records [27]. More over surgery avoids the long-term systemic side effects of ATD and radiation exposure of RAI. Though a matter of debate, patients having chosen surgery as a definitive treatment are likely to be more satisfied compared to RAI [5, 28]. Patients preference should always be taken into consideration. Patients are likely to browse the internet for more information. However, the both reliability and comprehension of available information is occasionally questionable [29]. Hence, the treating physician should make available to the patient pertinent information so that patient can make an un biased decision which will further improve compliance and satisfaction to treatment.
