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

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• 作者：Vincent T. Wu ; MD ; Allison W. Lorenzen ; MD ; Anna C. Beck ; MD ; Vincent J. Reid ; MD ; Sonia L. Sugg ; MD ; James R. Howe ; MD ; Janet H. Pollard ; MD ; Geeta Lal ; MD ; MSc ; Ronald J. Weigel ; MD ; PhD ; ^{Ronald-Weigel@uiowa.edu}
• 刊名：Surgery
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：161
• 期：1
• 页码：147-155
• 全文大小：390 K
• 卷排序：161

文摘

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.MethodsThis 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.Results131I 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.ConclusionA 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.