ThyroidComparative analysis of radioactive iodine versus thyroidectomy for definitive treatment of Graves disease
Section snippets
Methods
After Institutional Review Board approval, a retrospective chart review was conducted encompassing both pediatric (<18) and adult patients undergoing radioactive iodine (n = 295) and/or thyroidectomy (n = 103) for GD between 2003 through 2015. A surgical database was compiled from endocrine surgeons at 5 University of Iowa Hospitals and Clinics (UIHC), and an RAI database was provided by the Department of Nuclear Medicine at UIHC. Both databases were used to collect demographic, clinical,
Results
A final cohort of 103 surgical patients and 295 RAI patients were identified and included for analysis (Table I). Overall, RAI patients were significantly older than those undergoing thyroidectomy (mean age 39.1 vs 33.14, respectively, P < .001). Adults constituted 82.5% of the operative group, while 17.5% were pediatric patients; in contrast, 90.8% were adults and 9.2% were pediatric patients in the RAI group. A higher proportion of pediatric patients were in the operative group than the RAI
Discussion
Few studies directly compare the definitive treatments for GD, and agreement regarding the best approach for management continues to be developing. In European countries, ATDs tend to be the primary treatment. Surgery or RAI is reserved for cases of recurrence, adverse effects of ATDs, or failure of ATDs6, 9, 10, 14; however, in the United States, RAI tends to be the preferred treatment with operation referral in the presence of potential or confirmed malignancy, in cases of large goiters
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Cited by (21)
Racial disparities in comorbid conditions among patients undergoing thyroidectomy for Graves’ disease: An ACS-NSQIP analysis
2021, American Journal of SurgeryCitation Excerpt :Differences in preoperative characteristics between different groups of patients suggest either a difference in access to care or a difference in decision making by a provider. Published studies have shown that the primary reason for thyroidectomy in GD is patient preference in 19–44% of cases7,12–14 This suggests that the patient-provider discussion is extremely important when deciding upon a definitive treatment modality for GD. Multiple factors may influence patient’s preference for thyroidectomy over another management strategy.
Assessment and Management of Thyroid Disease in Children
2019, Otolaryngologic Clinics of North AmericaCitation Excerpt :RAI is contraindicated in pregnancy and patients should avoid pregnancy for 6 months after treatment. Surgery with total thyroidectomy may be used in patients with large thyroid goiter, age under 5 years, severe Graves orbitopathy, low RAIU, patients who are interested in immediate symptom resolution, and those with high risk of recurrence.7 Preoperatively, patients should be treated with antithyroid medications until euthyroid with use of methimazole, β-blockers, inorganic iodine, and steroids to minimize intraoperative bleeding and risk of thyrotoxicosis.
Surgical management of pediatric thyroid disease: Complication rates after thyroidectomy at the Children's Hospital of Philadelphia high-volume Pediatric Thyroid Center
2019, Journal of Pediatric SurgeryCitation Excerpt :This complication has predominantly influenced pediatric endocrinologists to recommend radioactive iodine ablation in lieu of surgery for definitive treatment of GD and has resulted in partial thyroidectomy or avoidance of central neck dissection in the setting of PTC. Recently, high-volume, multidisciplinary surgical teams have begun to report better outcomes, and accordingly surgery is increasingly chosen over radioactive iodine therapy for GD [30]. The risk of permanent hypoparathyroidism in the hands of low-volume surgeons is evident in the literature, with one study reporting a 20% permanent incidence [25].
Radionuclide Therapies and Correlative Imaging
2023, Radiology-Nuclear Medicine Diagnostic Imaging: A Correlative ApproachOutcomes of Radioactive Iodine Versus Surgery for the Treatment of Graves’ Disease: a Systematic Review and Meta-analysis
2023, Indian Journal of Surgery
Supported by a National Institutes of Health grant T32#CA148062 (PI:R.J.W.). (V.T.W. and A.W.L. were supported by NIH grant T32CA148062.)
The authors declare that they have no conflicts of interest.