Greater Efficacy of Total Thyroidectomy versus Radioiodine Therapy on Hyperthyroidism and Thyroid-Stimulating Immunoglobulin Levels in Patients with Graves' Disease Previously Treated with Antithyroid Drugs.
OBJECTIVE
We compared the effects of total thyroidectomy (TTx) and radioiodine (RAI) administration on the course of thyroid hormones and thyroid-stimulating immunoglobulins (TSI) in patients with Graves' disease.


METHODS
We retrospectively studied 80 patients initially treated with antithyroid drugs and requiring either RAI (8.3 ± 1.7 mCi of (131)I; n = 40) or TTx (n = 40) as second-line therapy.


RESULTS
The TTx and RAI groups were not different, except for larger goiter, higher FT3 and more frequent Graves' orbitopathy at diagnosis in the surgery group (p < 0.05). A persistent remission of hyperthyroidism was observed in 97% of operated patients versus 73% of the RAI patients at 3 years (p < 0.01). TTx was followed by a rapid and steady decrease in TSI during the first 9 months, while a surge of antibodies was observed during the first 6 months after RAI, followed by a slow decrease over the next 18 months. At the last visit, high TSI levels were still observed in 18 and 60% of patients in the surgery and RAI groups, respectively (p < 0.001).


CONCLUSIONS
TTx is more efficient than RAI to induce a rapid and permanent correction of hyperthyroidism and TSI decrease in patients previously treated with antithyroid drugs.
Division of Endocrinology and Nutrition, St. Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
Shakeel
S
Kautbally
Division of Endocrinology and Nutrition, St. Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
Orsalia
O
Alexopoulou
Division of Endocrinology and Nutrition, St. Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
Chantal
C
Daumerie
Division of Nuclear Medicine, St. Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
François
F
Jamar
Division of Endocrine Surgery, St. Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
Michel
M
Mourad
Division of Endocrinology and Nutrition, St. Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium.
Dominique
D
Maiter
Graves' disease; Hyperthyroidism; Radioiodine therapy; Thyroid-stimulating immunoglobulin; Total thyroidectomy