[Treatment of Basedow-Graves' hyperthyroidism: retrospective analysis after 30 years].
BACKGROUND
It is still debated which is the best treatment for Basedow-Graves' hyperthyroidism (BGH). We reviewed 195 patients treated and followed-up during the past 30 years: 88 treated with propylthiouracil (PTU), 70 with 131I and 37 thyroidectomized.


OBJECTIVE
to analyze the efficacy of each therapy in terms of achieving euthyroidism and the search of possible indexes for success. Surgery attained euthyroidism in 70.2% but has disadvantages; 131I accounted for the highest hypothyroid rate (72.1%) irrespective of the dose administered; PTU alone was successful in only 26.4% but combined with T4, success rose to 62.5% (p < 0.025). Suppression test and/or TRAb measurements after 6 mo PTU therapy were used to decide if therapy continued or was changed to other form of treatment. Using this criteria, 87.5% of pts with positive results achieved longstanding euthyroidism. Pretreatment predictive indexes were goiter size, T4 levels and 24 h/RAI uptake.


CONCLUSIONS
As 131I induces hypothyroidism in over 2/3 of pts and surgery besides its cost is not devoid of serious complications, we advocate for the use of PTU as first line therapy; combined treatment (PTU + T4) seems promising. If after 6 mo on PTU, TRAb or Suppression test do not improve, we recommend 131I or surgery.
Pineda
G
G
Departamento de Medicina, Hospital Salvador, Universidad de Chile y Laboratorio IEMA. IEMA@REUNA.CL
Arancibia
P
P
Mejía
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D013956:Antithyroid Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006111:Graves Disease / Q000150:complications*; D006801:Humans; D006980:Hyperthyroidism / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011441:Propylthiouracil / Q000627:therapeutic use*; D012189:Retrospective Studies; D013965:Thyroidectomy; D016896:Treatment Outcome
D013956:Antithyroid Agents; D007457:Iodine Radioisotopes; D011441:Propylthiouracil
Tratamiento del hipertiroidismo por enfermedad de Basedow-Graves: visión retrospectiva al cabo de 30 años.