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

Abstract

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. 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. 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. 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.