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Increased thyroid function (hyperthyroidism) is a disorder that is commonly caused by a condition called Graves' disease. This is an autoimmune disorder affecting the thyroid gland. Treatment options for hyperthyroidism due to Graves' disease include the use of anti-thyroid drugs, radioactive iodine, and surgery.

Treatment

Most doctors in the United States prefer to treat patients using antithyroid drugs such as methimazole and propylthiouracil, followed by radioactive iodine when treatment fails. Total thyroidectomy is done only when hyperthyroidism persists in spite of medical therapy, or if the patient has a multinodular goiter.

In a few cases, eye disease (ophthalmopathy) related to hyperthyroidism and patient preference play a role in the decision to remove the thyroid gland. Other conditions that may require total thyroidectomy include benign nontoxic goiter and thyroid cancer.

Thyroidectomy is not commonly used as first line of treatment for Graves' disease because of the potential post-operative complications such as permanent decrease in calcium levels (hypocalcemia) and damage to the recurrent laryngeal nerve. These are serious complications, which are difficult to treat, but for many patients, the most dreaded complication of total thyroidectomy is significant weight gain.

Causes

In the past, it was believed that the reason for post-thyroidectomy weight gain was that the patient regained the body weight he /she lost during the period of hyperthyroidism, which increased his/her metabolism. Another reason offered for weight gain after surgery is inadequate replacement of thyroid hormones after removal of the thyroid gland. The thyroid produces hormones that regulate body metabolism, so after removal of the gland, patients have to take hormones to replace those that should come from a normal thyroid gland.

Another factor that has been considered to be responsible for post-thyroidectomy weight gain is associated with the transient hypothyroidism (underactive or slow metabolism) in the period after surgery. Studies suggest that an increase in body weight within 40 to 60 days after surgery is highly predictive of weight gain at nine months, suggesting that factors related to thyroidectomy itself may play a role. Some studies show that patients can gain up to 10 kg of body weight per year after total thyroidectomy, while other studies found a much lower mean increase in weight (about 2.4 kg).

Many surgeons prefer to do a partial thyroidectomy rather than a total thyroidectomy whenever it is possible to avoid serious complications. It is also important to follow strictly your hormone replacement therapy after thyroidectomy to ensure balance in your metabolism. Ask your doctor about other medications or supplements you are taking, which may interfere with the absorption or action of your thyroid hormones.

Aside from these, it is important to remember that diet and lifestyle factors play an important role in weight gain, no matter what medical condition you have. Talk to your doctor or a registered dietitian about the proper diet to adopt after total thyroidectomy. Eat a healthy, balanced diet that is low in calorie, but high in nutrients. Exercise regularly and avoid unhealthy lifestyle habits that may increase weight gain.

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