Outcomes of Graves’ Disease Patients Following Antithyroid Drugs, Radioactive Iodine, or Thyroidectomy as the First-line Treatment

Liu, Xiaodong; Wong, Carlos King Ho; Chan, Wendy; Tang, Eric Ho Man; Woo, Yu Cho; Lam, Cindy L. K.; Lang, Brian Hung-Hin

doi:10.1097/sla.0000000000004828

Cited by 25 publications

(29 citation statements)

References 38 publications

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“…The current standard of care for the definitive management of hyperthyroidism caused by AFTNs is surgery and RAI ablation. Thyroidectomy allows definitive cure, however it by default carries with it a relatively large risk of permanent hypothyroidism, recurrent laryngeal nerve injury, and hypoparathyroidism ( 30 , 31 ). RAI, while effective, treats a patient with exogenous radioactive elements which, according to a recent meta-analysis, displays a linear-dose response relationship with solid cancer mortality ( 32 ).…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency ablation as a novel modality in the USA for treating toxic thyroid nodules: case series and literature review

Kandil¹,

Omar²,

Attia³

et al. 2022

Gland Surg

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Background: Radiofrequency ablation (RFA) is widely accepted as a treatment for non-functioning benign thyroid nodules, mainly to reduce compressive symptoms. In addition to potential compressive symptoms, autonomously functioning thyroid nodules (AFTNs) can cause palpitations, weight loss, diarrhea, increased appetite, flushing, irritability, tiredness, poor sleep, and long-term cardiovascular and musculoskeletal consequences. Currently, there are no United States based RFA practice guidelines for the treatment of AFTNs. However, several reports from Asia and Europe have described the resolution of hyperthyroidism secondary to AFTNs with RFA.Case Description: Three patients with toxic thyroid nodules presented with symptomatic hyperthyroidism, suppressed thyroid-stimulating hormone (TSH), and increased uptake on nuclear medicine thyroid scan. These patients were treated with RFA. At 3 months following ablation, TSH normalized to 2.09, 1.91, and 1.34 mIU/mL respectively. However, temporary hypothyroidism was encountered at 1 month following ablation. All patients discontinued their antithyroid medications following ablation. Nodules exhibited significant volume reductions of 38%, 32%, and 54% from the baseline at 1-month follow-up.Conclusions: RFA potentiates as a safe and effective treatment of toxic thyroid nodules. Though it carries a risk of temporary hypothyroidism following ablation, long-term consequences appear to be minimal.Future study with larger sample size and longer follow-up are encouraged to identify factors predicting response.

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Section: Discussionmentioning

confidence: 99%

Radiofrequency ablation as a novel modality in the USA for treating toxic thyroid nodules: case series and literature review

Kandil¹,

Omar²,

Attia³

et al. 2022

Gland Surg

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“…This system was developed in 1994, providing clinicians with the chance to record and obtain data from an integrated platform 13 . This system links up all major public hospitals, accounting for about 90 per cent of all in-hospital health services across the territory 14 . The completeness rates of 100 per cent and 99.98 per cent in patients’ demographic and prescription records have been reported by previous evidence, validating the quality of the data set 15 .…”

Section: Methodsmentioning

confidence: 99%

“…A high positive predictive value of the database also has been verified by recent studies 16 , 17 . This database has been utilized in previous publications on thyroid disease 14 , 18 , 19 .…”

Section: Methodsmentioning

confidence: 99%

Survival after hemithyroidectomy versus total thyroidectomy in non-high-risk differentiated thyroid cancer: population-based analysis

et al. 2022

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Background The extent of thyroid surgery remains controversial for differentiated thyroid cancers (DTCs) that measure more than 1 cm but are not considered high risk. This study aimed to compare survival outcomes between hemithyroidectomy (HT) and total thyroidectomy (TT) in non-high-risk DTCs. Methods A population-based retrospective cohort of patients with non-high-risk DTCs more than 1 cm undergoing HT or TT between 1997 and 2017 in a territory with 41 public hospitals and clinics serving a population of 7 million was analysed. Multivariable Cox proportional hazards regression models adjusted for patient demographics and clinical parameters were used to compare the overall, disease-specific, and recurrence-free survival between TT and HT. Risks of postoperative complications were compared between the two groups. Results A total of 4771 patients (HT, 1368; TT, 3403) underwent thyroid surgery as a primary treatment. Median (range) follow-up was 117 (range: 72–179) months. Patients in the TT and HT groups had comparable risks of overall survival (HR 0.87; 95 per cent c.i. 0.73 to 1.04; P = 0.119) and disease-specific survival (HR 0.85; 95 per cent c.i. 0.52 to 1.40; P = 0.518). The TT group had better recurrence-free survival (HR 0.37; 95 per cent c.i. 0.26 to 0.52; P < 0.001) than the HT group. The temporary and permanent hypoparathyroidism rates in TT group were 14.96 per cent and 7.49 per cent respectively; none were reported in the HT group. Conclusions Despite the comparable overall and disease-specific survivals, TT was associated with better recurrence-free survival than HT in a 10-year follow-up. This was at the expense of higher surgical morbidity rate in TT.

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“…This study demonstrates long-term advantages to performing thyroidectomy as initial treatment for patients with Graves' disease. Patients undergoing thyroidectomy as a first-line therapy as compared with those treated with ATDs or RAI had lower all-cause mortality and a lower risk of cardiovascular diseases (2). Long-term direct health care costs are lower for those who undergo thyroidectomy secondary to low failure rates from definitive treatment.…”

Section: Commentarymentioning

confidence: 99%

Long-Term Benefits of Thyroidectomy for Graves’ Disease

Morris‐Wiseman

2021

Clinical Thyroidology

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BackgroundGraves' disease, the most common cause of hyperthyroidism, has typically been treated sequentially with antithyroid drugs (ATDs), then radioactive iodine (RAI) for patients for whom initial medical management fails. Surgery is traditionally reserved for patients with contraindications to radiation or ophthalmopathy or a need for rapid control of hyperthyroidism. Only approximately 6% of patients in the United States undergo thyroidectomy for initial management of Graves' disease (1). This study aimed to compare, by first-line treatment, long-term outcomes of patients with Graves' disease (including all-cause mortality, cardiovascular disease, atrial fibrillation, neuropsychiatric symptoms, diabetes, and hypertension), 10-year health care costs, and risk of relapse (2).

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Outcomes of Graves’ Disease Patients Following Antithyroid Drugs, Radioactive Iodine, or Thyroidectomy as the First-line Treatment

Abstract: Supplemental Digital Content is available in the text

Cited by 25 publications

References 38 publications

Radiofrequency ablation as a novel modality in the USA for treating toxic thyroid nodules: case series and literature review

Radiofrequency ablation as a novel modality in the USA for treating toxic thyroid nodules: case series and literature review

Survival after hemithyroidectomy versus total thyroidectomy in non-high-risk differentiated thyroid cancer: population-based analysis

Long-Term Benefits of Thyroidectomy for Graves’ Disease

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