Long-term risks in hyperthyroid patients treated with radioiodine: is there anything new?

Excerpt

Surgery, radioiodine (RAI) and antithyroid drugs remain the main treatments in use today to cure Graves’ disease, solitary toxic thyroid nodules and toxic multinodular goitre [1, 2]. The treatment selection depends on many factors, including the clinician’s and patient’s preferences, the availability of a skilled surgeon, cost and local limitations on the therapeutic use of radioisotopes. A survey conducted more than 15 years ago among North American thyroid specialists concerning the treatment of a hypothetical patient with Graves’ disease found that 69% chose RAI as the preferred treatment. In Europe and Japan, RAI is less popular, being chosen as first-line therapy by only 22% and 11% of thyroid specialists, respectively [3]. It is worth noting that cost per “cure” has been calculated to be US $5,644 per patient who receives thionamides, $2,063 per patient given RAI and $9,826 per patient who undergoes thyroidectomy; the most cost-effective primary treatment modality for thyrotoxicosis is therefore RAI [4]. Pregnancy and breast feeding remain the only absolute contraindications to the use of RAI. Guidelines for the use of RAI are available from the web sites of nuclear medicine professional associations [5, 6]. RAI continues to be part of clinical practice and the object of continuous reassessments and optimisation. …