I was dx'd with Graves in 1996. My husband and I opted for surgery after 18 mos. of Tapazole and a relapse 3 months later.

While discussing the options with my endocrinologist, he cautioned me about the surgery and it's risks, particularly with this type of surgery.

Within your thyroid tissue lies your laryngeal nerve. Anatomically, it's generally in the same location in everyone. The problem is that if your glandular tissue is more dense, it takes an extremely skilled surgeon to excise the gland without disturbing that nerve. If it is so much as nicked, you may wind up with problems with your vocal cords.

Another serious risk is that of the parathyroid glands. There are four of them in the thyroid. These regulate, among other things, your blood calcium levels. If these are merely nicked or worse, damaged, you will be receiving calcium shots for the rest of your life.

Now this is not to say that this surgery should be tossed in the "round file." To the contrary, some patients have had the good fortune to find a surgeon who does nothing but thyroidectomies, and do them successfully. (I don't think that the entire gland is removed, however.)

So with that knowledge, my husband and I decided that RAI-131 was a better way to go. Not that radio active "anything" is neccessarily considered 100% safe. But, it worked for me. There were precautions I had to take for just a few days after the treatment. I had flu-like symptoms about 10 days after that. Technicians will tell you that "you will not have any side effects." My endo told me otherwise.

I am now on Armour, after years of Synthroid and Levoxyl, only to have my TSH rise to 129 and 150. The Armour has been the charm. I must add, however, that I take a lot of different medications for other illnesses, so you may not run into this problem.

They will calculate your weight with other factors to determine the amount of millicuries of RAI-131 to administer (in the form of a capsule). I had 22 millicuries and it did the trick.

If you decide on the surgery, ask your doctor if he/she knows of a surgeon who either does nothing but, or at least a great amount of thyroidectomies per year or even per month. This is not a surgery I would entrust to a general surgeon, even a good one.

The RAI-131 is really a walk in the park. For real. Your doctor will order the rai capsule and a reuptake will be done approximately 3 hours later to see if the gland is hyper or hypo; rule out a goiter. This is done via thermal imagery. Then you are started on thyroid HRT. For the first 3-4 days, you will need to avoid close proximity with small children; and this is a bit delicate, but when you use the "loo," flush first, then use, then flush TWICE. This is because the RAI, once it has been absorbed by the thyroid gland, the rest just passes out the body. And remember, this is radio-active iodine that is in your body. It is not enough to do irreparable harm, however. They used to quarantine patients who required anywhere upwards of 29 millicuries, but I don't know if that is done anymore. It's in your persperation and body waste, so that is why the avoidance of contact with small children. Some will tell you you should not sleep in the same bed with your spouse/SO for the same reason, but my doctor told me that wasn't necessary. RAI and young children...something about their little disease-free bodies absorbing what little RAI via your skin into theirs. I think I have stated this correctly, if memory serves.

But really, I am happy I decided NOT to opt for the surgery. However, as said before, there are people who have had the surgery (my endo's secretary was one) and she was alternating days for hypo and hyper thyroid. She'd gone into thyroid storm and nearly stroked out and died in the ER. That was how she met my endo and became his patient and later an employee of his.

Do as much research as you can on both options and choose the one that is right for YOU. Discuss it with your doctor and he will be able to help you make that decision.

Hugs and peace out!