Elsevier

Surgery

Volume 161, Issue 1, January 2017, Pages 147-155
Surgery

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

Presented at the American Association of Endocrine Surgeons Annual Meeting, April 10, 2016, to April 12, 2016, Baltimore, MD.
https://doi.org/10.1016/j.surg.2016.06.066Get rights and content

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.

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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    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.

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