HYPERTHYROIDISM-
SURGERY OR RADIOIODINE ABLATION THERAPY (RIA)?
RIA is a
definitive medical treatment for Graves disease, with an 131-I dose of 150 to
200 mCi/g. Ablation is then achieved over 12 to 18 weeks.
-Although
RIA can produce high cure rates, there is still an 8 % failure rate in the
recent literature
-RIA can
cause exacerbation of Graves’ disease (pretreatment with beta blockers and antithyroid
drugs [ATD] should be considered even in asymptomatic but high risk patients,
such as elderly patients and patients with significant comorbidities)
-RIA is
associated with increased risk of ophthalmopathy
-RIA is
contraindicated in pregnancy and breastfeeding
-Potential
pregnancy should be avoided for at least 6 months after RIA
-RIA may
cause radiation thyroiditis in a small percentage of patients (~ 1.5 %)
However,
RIA should be considered for:
- Patients
with an increased risk of surgery
- Patients
unwilling to undergo surgery
- Patients with
previously operated or externally irradiated neck (total thyroidectomy can
safely be performed by an experienced endocrine surgeon in this group of patients)
SURGERY is
the oldest form of treatment for Graves disease.
- Surgery
is highly effective (~ 100 % cure rate) with immediate therapeutic response
- Surgery
is associated with the lowest relapse rate compared to RIA and ATDs
- Surgery
is the treatment of choice in:
(I) Patients with large goiters
(II) Patients with goiters (diffuse or nodular)
causing pressure symptoms (airway obstruction / dysphagia)
(III) Patients with moderate to severe ophthalmopathy
(RIA may worse ophthalmopathy)
(IV) Pregnant or breastfeeding women
(V) Patients with persistent hyperthyroidism
after RIA
(VI) Patients with a nodule suspicious for underlying
malignancy (based on results of ultrasonography and FNA)
(VII) Patients with coexistent
hyperparathyroidism
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