Incidental Thyroid Cancer in Graves' Disease Patients

Inclusion Criteria: * Age 18 years or older. * Confirmed diagnosis of Graves' disease based on clinical features (e.g., diffuse goiter, ophthalmopathy if present) and biochemical evidence (suppressed TSH, elevated free T4 and/or T3) and/or positive TSH receptor antibody (TRAb) test. * Indication for total thyroidectomy for Graves' disease, based on established guidelines: Relapse or persistence of hyperthyroidism after a course of antithyroid drugs (ATDs). Intolerance or adverse reaction to ATDs. Patient preference for surgery over radioactive iodine (RAI) or long-term ATDs. Presence of a large goiter causing compressive symptoms. Coexisting suspicious thyroid nodule(s) on preoperative evaluation. Moderate to severe active Graves' ophthalmopathy where RAI is relatively contraindicated. * Patient is scheduled for total thyroidectomy (near-total or subtotal thyroidectomy patients will be excluded). * Ability and willingness to provide written informed consent. * Ability to understand study procedures and requirements. Exclusion Criteria: * Age less than 18 years. * Previous thyroid surgery. * Previous neck irradiation. * Preoperative diagnosis of thyroid malignancy confirmed by fine-needle aspiration (FNA) cytology (Bethesda V or VI) , the focus is on incidental carcinoma. * Inability to provide informed consent (e.g., due to cognitive impairment). * Patients undergoing thyroidectomy primarily for reasons other than Graves' disease (e.g., primary indication is large non-toxic MNG). * Patients undergoing less than total thyroidectomy (e.g., lobectomy, subtotal thyroidectomy).