Liječnički vjesnik, Vol. 132 No. 11-12, 2010.
Professional paper
RADIOIODINE VERSUS SURGERYIN THE TREATMENT OF GRAVES’ HYPERTHYROIDISM
TOMISLAV JUKIĆ
JOSIP STANIŠIĆ
VLADO PETRIC
ZVONKO KUSIĆ
Abstract
The most common etiologic cause of thyrotoxicosis in children and adults is autoimmune Graves’ (Basedow’s) disease. Anti thyroid medications, surgery and radioactive iodine have been used in the treatment of Graves’ hyperthyroidism for more than six decades. The use of antithyroid drugs is the most common therapeutic approach. However, long-term remission with antithyroid drugs can be expected in 20–50% of adults and 20–30% of children. The methods for definitive
treatment of Graves’ hyperthyroidism are iodine-131 (radioiodine) and surgery. Both treatment modalities have benefits and risks and the decision is made according to the age, patient preference and the presence of other co-morbidities, individual characteristics of patients and the availability of certain treatment modality. Radioiodine is simple, safe, effective and economic procedure for definitive treatment of Graves’ hyperthyroidism. It is administered ambulatory and can be given to the patient in thyrotoxicosis. Due to many benefits, radioiodine is preferred in most of the adult patients with Graves’ hyperthyroidism while only small proportion of patients is sent to surgery. Radioidine is especially the treatment of choice in elderly patients and patients with heart disease. In these patients radioiodine is indicated immediately after reaching euthyroidism with antithyroid drugs. Surgery is mainly indicated in younger patients, in the case of patient preference or in special indications. Clear indications for surgical treatment of Graves’ hyperthyroidism are: suspected or confirmed malignancy, coexisting pathology that demands surgical treatment, pregnancy and breastfeeding, large goiter (> 80 grams) or goiter with symptoms and signs of compression, severe toxic side effects of antithyroid medications, requirement for immediate control of disease, age younger than 5 years and active ophtalmopathy. The risk of surgical treatment is negatively correlated with the surgeon’s experience and nowadays, total or near-total thyroidectomy is preferred surgical approach. End point of both treatment modalities is usually hypothyroidism that should not be considered as the consequence of treatment. Moreover, due to thyroid hormones replacement therapy equilibrium can be easily achieved.
Keywords
Graves disease – radiotherapy, surgery; Iodine radioisotopes – therapeutic use, administration and dosage, adverse effects
Hrčak ID:
221463
URI
Publication date:
31.12.2010.
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