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What Is the Best Definitive Treatment for Graves’ Disease? A Systematic Review of the Existing Literature

  • Endocrine Tumors
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists for Graves’ disease (GD) include any of the following modalities: 131I therapy, antithyroid medication, or thyroidectomy. No in-depth analysis has been performed comparing the treatment options, even though a single treatment option seems to be universally accepted.

Methods

A systematic review of the literature was performed to examine contemporary literature between 2001 and 2011 evaluating the management options of GD. We compiled retrospective and prospective studies analyzing surgery and radioactive iodine. Outcomes of interest included postoperative hypothyroidism, euthyroidism, and persistent or recurrent hyperthyroidism without supplementation. Success was defined as postoperative euthyroidism or hypothyroidism. Failure was defined as persistent or recurrent hyperthyroidism.

Results

Of the 14,245 patients, 4,546 underwent surgery [3,158 patients had subtotal thyroidectomy (STT) and 1,388 had total thyroidectomy (TT)] and 9,699 had radioactive iodine. The radioactive iodine group consisted of 2,383 patients receiving 1–10 mCi, 1,558 patients receiving 11–15 mCi, 516 patients receiving >15 mCi, and 5,242 patients receiving an unspecified amount. Surgery was found to be 3.44 times more likely to be successful than radioactive iodine (p < 0.001). STT and TT were found to be 2.33 and 94.45 times more likely to be successful than radioactive iodine (p < 0.001), respectively.

Conclusions

On the basis of the outcomes analyzed, surgery appears to be the most successful in the management of GD, with TT being the preferred surgical option.

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Authors and Affiliations

  1. Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA

    Bradley M. Genovese MD, Salem I. Noureldine MD, Elizabeth M. Gleeson BS, MPH & Emad Kandil MD, FACS

  2. Division of Head and Neck Cancer Surgery, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA

    Ralph P. Tufano MD, FACS

  3. Department of Surgery, Tulane University School of Medicine, 1430 Tulane Ave, Room 8510 (Box SL-22), New Orleans, LA, 70112, USA

    Emad Kandil MD, FACS

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  1. Bradley M. Genovese MD
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Genovese, B.M., Noureldine, S.I., Gleeson, E.M. et al. What Is the Best Definitive Treatment for Graves’ Disease? A Systematic Review of the Existing Literature. Ann Surg Oncol 20, 660–667 (2013). https://doi.org/10.1245/s10434-012-2606-x

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