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

Vincent T Wu; Allison W Lorenzen; Anna C Beck; Vincent J Reid; Sonia L Sugg; James R Howe; Janet H Pollard; Geeta Lal; Ronald J Weigel

doi:10.1016/j.surg.2016.06.066

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

Journal article

Peer reviewed

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

Vincent T Wu, Allison W Lorenzen, Anna C Beck, Vincent J Reid, Sonia L Sugg, James R Howe, Janet H Pollard, Geeta Lal and Ronald J Weigel

Surgery, Vol.161(1), pp.147-155

01/2017

DOI: 10.1016/j.surg.2016.06.066

PMCID: PMC5492886

PMID: 27863789

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Abstract

Management of Graves disease includes antithyroid drugs, I therapy, or thyroidectomy. Our aim was to review our institutional experience with definitive treatments for Graves disease. This was a retrospective review of patients undergoing I therapy (n = 295) or thyroidectomy (n = 103) for Graves disease (2003-2015). Demographic, clinical, pathology, and outcome data were collected from institutional databases. I 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 I therapy (17.1% vs 9.2%, P = .026). The success rate of the first I therapy dose was 81.4%. Overall success rate, including additional doses, was 90.1%. Rapid turnover of iodine correlated with I 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. I therapy complications included worsening thyrotoxicosis (1%) and deteriorating orbitopathy (0.7%). Operative complications were higher than I therapy complications (P < .05) but were transient. There was no worsening orbitopathy or recurrent Graves disease among surgical patients. A higher proportion of pediatric Graves disease patients underwent thyroidectomy than I therapy. Rapid turnover suggested more effective initial management with operation than I therapy. Although transient operative complications were high, I therapy complications included worsening of Graves orbitopathy among those with pre-existing orbitopathy.

Graves Disease - diagnosis

Follow-Up Studies

Graves Ophthalmopathy - surgery

Humans

Male

Iodine Radioisotopes - therapeutic use

Time Factors

Adult

Female

Retrospective Studies

Child

Databases, Factual

Severity of Illness Index

Postoperative Complications - physiopathology

Graves Disease - surgery

Risk Assessment

Thyroidectomy - methods

Treatment Outcome

Postoperative Complications - epidemiology

Graves Ophthalmopathy - radiotherapy

Thyroidectomy - adverse effects

Graves Disease - radiotherapy

Graves Ophthalmopathy - diagnosis

Adolescent

Dose-Response Relationship, Radiation

Cohort Studies

Details

Title: Subtitle: Comparative analysis of radioactive iodine versus thyroidectomy for definitive treatment of Graves disease
Creators: Vincent T Wu - Departments of Surgery and Radiology, University of Iowa, Iowa City, IA
Allison W Lorenzen - Departments of Surgery and Radiology, University of Iowa, Iowa City, IA
Anna C Beck - Departments of Surgery and Radiology, University of Iowa, Iowa City, IA
Vincent J Reid - Departments of Surgery and Radiology, University of Iowa, Iowa City, IA
Sonia L Sugg - Departments of Surgery and Radiology, University of Iowa, Iowa City, IA
James R Howe - Departments of Surgery and Radiology, University of Iowa, Iowa City, IA
Janet H Pollard - Departments of Surgery and Radiology, University of Iowa, Iowa City, IA
Geeta Lal - Departments of Surgery and Radiology, University of Iowa, Iowa City, IA
Ronald J Weigel - Departments of Surgery and Radiology, University of Iowa, Iowa City, IA. Electronic address: Ronald-Weigel@uiowa.edu
Resource Type: Journal article
Publication Details: Surgery, Vol.161(1), pp.147-155
DOI: 10.1016/j.surg.2016.06.066
PMID: 27863789
PMCID: PMC5492886
NLM abbreviation: Surgery
ISSN: 0039-6060
eISSN: 1532-7361
Publisher: Elsevier BV; United States
Grant note: T32 CA148062 / NCI NIH HHS
Language: English
Date published: 01/2017
Academic Unit: Radiology; Molecular Physiology and Biophysics; Anatomy and Cell Biology; Stead Family Department of Pediatrics; Surgery; Biochemistry and Molecular Biology
Record Identifier: 9984024402702771

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