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Thyroidectomy offers the highest success rates for both primary and persistent disease, yet it is the least recommended or utilized option reaching &lt;1% for primary disease and &lt;25% for persistent disease. Several surveys have found surgery to be the least recommended by endocrinologists worldwide. With the development of remote access thyroidectomies and intraoperative nerve monitoring of the recurrent laryngeal nerve, combined with current knowledge of possible risks associated with RAI or failure of ATDs, revaluation of the benefit to harm ratio of surgery in the treatment of GD is warranted. The aim of this review is to discuss possible reasons for the low proportion of surgery in the treatment of GD, emphasizing an evidence\u2010based approach to the clinicians\u2019 preferences for surgical referrals, surgical indications and confronting traditional reasons and concerns relating to the low referral rate with up\u2010to\u2010date data.<\/jats:p>","DOI":"10.1111\/cen.14653","type":"journal-article","created":{"date-parts":[[2021,12,26]],"date-time":"2021-12-26T18:08:02Z","timestamp":1640542082000},"page":"747-757","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Revisiting the role of surgery in the treatment of Graves\u2019 disease"],"prefix":"10.1111","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8666-3571","authenticated-orcid":false,"given":"Oded","family":"Cohen","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Otolaryngology Yale University School of Medicine New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7084-0695","authenticated-orcid":false,"given":"Ohad","family":"Ronen","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery, Galilee Medical Center, affiliated with Azrieli Faculty of Medicine Bar\u2010Ilan University Safed Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Avi","family":"Khafif","sequence":"additional","affiliation":[{"name":"A.R.M. Center of Otolaryngology\u2014Head and Neck Surgery, Assuta Medical Center Affiliated with Ben\u2010Gurion University of the Negev Tel Aviv Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan P.","family":"Rodrigo","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology\u2014Head and Neck Surgery, Hospital Universitario Central de Asturias University of Oviedo, ISPA Oviedo Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricard","family":"Simo","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Head and Neck Surgery, Head and Neck and Thyroid Oncology Unit Guy's and St. Thomas' Hospital NHS Foundation Trust London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pia","family":"Pace\u2010Asciak","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2014Head and Neck Surgery University of Toronto Toronto Ontario 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D.","family":"Olsen","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5563-8840","authenticated-orcid":false,"given":"Alvaro","family":"Sanabria","sequence":"additional","affiliation":[{"name":"Department of Surgery, School of Medicine Universidad de Antioquia\u2010Ips Universitaria Medell\u00edn Colombia"},{"name":"CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello\u2014Cl\u00ednica Las Vegas\u2014Quir\u00f3n Medell\u00edn Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph P.","family":"Tufano","sequence":"additional","affiliation":[{"name":"Multidisciplinary Thyroid and Parathyroid Center, Head and Neck Endocrine Surgery Sarasota Memorial Health Care System Sarasota Florida USA"},{"name":"Division of Otolaryngology\u2014Endocrine Head and Neck Surgery, Department of Otolaryngology\u2014Head and Neck Surgery, Johns Hopkins University School of Medicine Johns Hopkins University  Baltimore Madison USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Babighian","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Ospedale Sant'Antonio, Azienda Ospedaliera  Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashok R.","family":"Shaha","sequence":"additional","affiliation":[{"name":"Head and Neck Surgery Memorial Sloan\u2010Kettering Cancer Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Zafereo","sequence":"additional","affiliation":[{"name":"Department of Head &amp; Neck Surgery Anderson Cancer Center  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfio","family":"Ferlito","sequence":"additional","affiliation":[{"name":"International Head and Neck Scientific Group  Padua 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