Change in Practice over Four Decades in the Management of Graves' Disease in Scotland.
There is continuing debate on the optimal treatment for Grave's thyrotoxicosis with a resultant variation in clinical practice. The present study aimed to ascertain changes in practice in the treatment of Grave's thyrotoxicosis in Tayside, Scotland, over the past four decades. Methods. The "Scottish automated follow-up register" (SAFUR) was queried to identify all patients treated for Grave's thyrotoxicosis from 1968 to 2007 inclusive. Patients were divided into 4 groups (Groups A to D) according to the decades. Demographic profile, treatment modalities, radioactive iodine (RAI) dose, and recurrence rates were studied and outcomes were compared by χ (2) test and ANOVA using SPSS v15.0. A p value of < 0.05 was considered significant. Results. Altogether, 3737 patients were diagnosed with Grave's thyrotoxicosis over the 4 decades. Use of RAI has increased from 43.1% in Group A to 68% in Group D (p < 0.001). The dose of RAI has increased (p < 0.001) and there has been a reduction in recurrence rate with higher dose of RAI. Surgical intervention rates decreased from 55.3% to 12.3% (p < 0.001) over time. Conclusions. Analysis of a large dataset of patients with Grave's thyrotoxicosis suggests increasing use of RAI as the preferred first line of treatment. Furthermore, using a single higher dose of RAI and adoption of total thyroidectomy have decreased recurrence rates.
Department of Surgery, Ninewells Hospital & Medical School, University of Dundee, Dundee DD1 9SY, UK.
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Smith
University Department of Surgery, Faculty of Medicine, University of Glasgow, Royal Infirmary, Glasgow G31 2ER, UK.
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Dutta
School of Medicine, Guy's King's & St. Thomas' Hospitals, King's College London, London SE1 1UL, UK.
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Ahmed
Academic Surgical Unit, Blizard Institute, National Centre for Bowel Research & Surgical Innovation, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London E1 1BB, UK.
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Thaha