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

Background. Management of Graves disease includes antithyroid drugs, I-131 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 I-131 therapy (n = 295) or thyroidectomy (n = 103) for Graves disease (2003-2015). Demographic, clinical, pathology, and outcome data were collected from institutional databases. Results. I-131 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 I-131 therapy (17.1% vs 9.2%, P=.026). The success rate of the first I-131 therapy dose was 81.4 %. Overall success rate, including additional doses, was 90.1%. Rapid turnover of iodine correlated with I-131 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. I-131 therapy complications included worsening thyrotoxicosis (1 %) and deteriorating orbitopathy (0.7%). Operative complications were higher than I-131. 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 I-131 therapy. Rapid turnover suggested more effective initial management with operation than I-131. therapy. Although transient operative complications were high, I-131 therapy complications included worsening of Graves orbitopathy among those with pre-existing orbitopathy.