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

BACKGROUND: Management of Graves disease includes antithyroid drugs, 131 I therapy, or thyroidectomy. Our aim was to review our institutional experience with definitive treatments for Graves disease.

METHODS: This was a retrospective review of patients undergoing 131 I therapy (n = 295) or thyroidectomy (n = 103) for Graves disease (2003-2015). Demographic, clinical, pathology, and outcome data were collected from institutional databases.

RESULTS: 131 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 131 I therapy (17.1% vs 9.2%, P = .026). The success rate of the first 131 I therapy dose was 81.4%. Overall success rate, including additional doses, was 90.1%. Rapid turnover of iodine correlated with 131 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. 131 I therapy complications included worsening thyrotoxicosis (1%) and deteriorating orbitopathy (0.7%). Operative complications were higher than 131 I therapy complications (P < .05) but were transient. There was no worsening orbitopathy or recurrent Graves disease among surgical patients.

CONCLUSION: A higher proportion of pediatric Graves disease patients underwent thyroidectomy than 131 I therapy. Rapid turnover suggested more effective initial management with operation than 131 I therapy. Although transient operative complications were high, 131 I therapy complications included worsening of Graves orbitopathy among those with pre-existing orbitopathy.