Comparative analysis of radioactive iodine versus thyroidectomy for definitive treatment of Graves disease

Abstract

Background Management of Graves disease includes antithyroid drugs, 131I therapy, or thyroidectomy. Our aim was to review our institutional experience with definitive treatments for Graves disease. Methods This was a retrospective review of patients undergoing 131I therapy (n = 295) or thyroidectomy (n = 103) for Graves disease (2003–2015). Demographic, clinical, pathology, and outcome data were collected from institutional databases. Results 131I therapy patients were older (39.1 years vs 33.4 years, P = .001). There was no difference in the presence of ophthalmopathy between groups. A larger proportion of children received thyroidectomy than 131I therapy (17.1% vs 9.2%, P = .026). The success rate of the first 131I therapy dose was 81.4%. Overall success rate, including additional doses, was 90.1%. Rapid turnover of iodine correlated with 131I therapy failure (58.3% rapid turnover failure vs 14.9% non–rapid turnover failure, P < .05). All surgical patients underwent total or near-total thyroidectomy. 131I therapy complications included worsening thyrotoxicosis (1%) and deteriorating orbitopathy (0.7%). Operative complications were higher than 131I therapy complications (P < .05) but were transient. There was no worsening orbitopathy or recurrent Graves disease among surgical patients. Conclusion A higher proportion of pediatric Graves disease patients underwent thyroidectomy than 131I therapy. Rapid turnover suggested more effective initial management with operation than 131I therapy. Although transient operative complications were high, 131I therapy complications included worsening of Graves orbitopathy among those with pre-existing orbitopathy.

Total thyroidectomy (Tx) versus thionamides (antithyroid drugs) in patients with moderate-to-severe Graves’ ophthalmopathy – a 1-year follow-up: study protocol for a randomized controlled trial

“…Thyroidectomy also provides definitive treatment, without exposure to radiation. Total thyroidectomy has also been shown to induce euthyroidism faster and more permanently (97%) than in patients who received RAI (73%), as well as less frequent persistence of GO, in accordance with other studies [ 6 , 21 , 22 , 26 , 27 , 30 ]. In addition, levels of thyroid-stimulating immunoglobulins also rapidly and steadily declined in patients who received total thyroidectomy compared to those who underwent RAI or who took ATD [ 30 ].…”

“…Definitive thyroid tissue ablation by RAI leads to lifelong hypothyroidism in up to 80% of patients. However, the patients are exposed to radiation which can cause a worsening of GO (radiation thyroiditis) due to a massive efflux of thyroid antigens from the thyroid that then stimulate antithyroid antibody production [ 19 – 27 ]. An exacerbation of preexisting ophthalmopathy can be prevented with therapy using orally administered glucocorticoids after RAI for anywhere between 6 and 12 weeks [ 6 , 28 , 29 ].…”

Surgical treatment for graves' disease: about 39 cases

“…L'euthyroïdie n'a été obtenue que 4 à 6 semaines après une cure d'iode radioactif ; parfois il faut attendre 6 mois pour l'obtenir [3]. Plusieurs études ont montré qu'une orbitopathie basedowienne peut être aggravée par un traitement par iode radioactif, et nécessite une évaluation pré-thérapeutique [6,8]. Les recommandations actuelles de l'association américaine de la thyroïde (ATA) est d'indiquer la chirurgie ou le traitement par les ATS en cas d'orbitopathie modérée ou sévère [5].…”

Definitive treatment of Graves’ disease in children and adolescents

“…A multidisciplinary health-care team that includes an endocrinologist, an experienced thyroid surgeon, and a nuclear medicine specialist would be optimal [16,18,19,39,40].…”