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Primary treatment of Graves’ disease: Comparison of radioiodine and antithyroid drugs.

Ian Robert Wallace

Abstract


Abstract

Thyrotoxicosis is a common condition, most frequently due to an autoimmune aetiology (Graves’ disease). There are three treatment options, antithyroid drugs (ATD), radioactive iodine (RI) or thyroidectomy, each with their own benefits and short-comings. Classically surgery is only used as primary treatment of Graves’ disease in patients with compressive symptoms or for cosmetic reasons with the majority of patients treated primarily with either RI or ATD. In this review I will discuss and compare these two treatment modalities (RI and ATD), focussing on efficacy, safety, side-effects, cost and quality of life. Graves’ orbitopathy (GO) is a rare, but potentially sight-threatening orbital manifestation of Graves’ disease and the relationship between ATD, RI and GO is also discussed. ATD are the only treatment modality presently available to have beneficial effects on the autoimmune aetiology by reducing TSH receptor antibody titre. I discuss novel agents which may have utility in the future. In conclusion, RI and ATD are both appropriate primary treatment modalities. Further research is require to identify more effective treatments aimed at ameliorating the autoimmune aetiology of Graves’ disease.


Keywords


Graves’ disease; Hyperthyroidism; Radioactive iodine; Methimazole; Carbimazole; Propylthiouracil; Graves’ orbitopathy

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References


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DOI: http://dx.doi.org/10.18103/mra.v2i5.410

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