title: Comparative analysis of radioactive iodine versus thyroidectomy for definitive treatment of Graves disease.
abstract: Management of Graves disease includes antithyroid drugs,131I therapy, or thyroidectomy. Our aim was to review our institutional experience with definitive treatments for Graves disease.
  
  
  
  This was a retrospective review of patients undergoing131I therapy (n = 295) or thyroidectomy (n = 103) for Graves disease (2003-2015). Demographic, clinical, pathology, and outcome data were collected from institutional databases.
  
  
  
  131I 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 than131I therapy (17.1% vs 9.2%, P = .026). The success rate of the first131I therapy dose was 81.4%. Overall success rate, including additional doses, was 90.1%. Rapid turnover of iodine correlated with131I 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.131I therapy complications included worsening thyrotoxicosis (1%) and deteriorating orbitopathy (0.7%). Operative complications were higher than131I therapy complications (P < .05) but were transient. There was no worsening orbitopathy or recurrent Graves disease among surgical patients.
  
  
  
  A higher proportion of pediatric Graves disease patients underwent thyroidectomy than131I therapy. Rapid turnover suggested more effective initial management with operation than131I therapy. Although transient operative complications were high,131I therapy complications included worsening of Graves orbitopathy among those with pre-existing orbitopathy.
authors.affiliation: Departments of Surgery and Radiology, University of Iowa, Iowa City, IA.
authors.forename: Vincent T
authors.initials: VT
authors.lastname: Wu
authors.affiliation: Departments of Surgery and Radiology, University of Iowa, Iowa City, IA.
authors.forename: Allison W
authors.initials: AW
authors.lastname: Lorenzen
authors.affiliation: Departments of Surgery and Radiology, University of Iowa, Iowa City, IA.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Beck
authors.affiliation: Departments of Surgery and Radiology, University of Iowa, Iowa City, IA.
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Reid
authors.affiliation: Departments of Surgery and Radiology, University of Iowa, Iowa City, IA.
authors.forename: Sonia L
authors.initials: SL
authors.lastname: Sugg
authors.affiliation: Departments of Surgery and Radiology, University of Iowa, Iowa City, IA.
authors.forename: James R
authors.initials: JR
authors.lastname: Howe
authors.affiliation: Departments of Surgery and Radiology, University of Iowa, Iowa City, IA.
authors.forename: Janet H
authors.initials: JH
authors.lastname: Pollard
authors.affiliation: Departments of Surgery and Radiology, University of Iowa, Iowa City, IA.
authors.forename: Geeta
authors.initials: G
authors.lastname: Lal
authors.affiliation: Departments of Surgery and Radiology, University of Iowa, Iowa City, IA. Electronic address: Ronald-Weigel@uiowa.edu.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Weigel
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D016208:Databases, Factual; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006111:Graves Disease / Q000175:diagnosis / Q000532:radiotherapy* / Q000601:surgery*; D049970:Graves Ophthalmopathy / Q000175:diagnosis / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007457:Iodine Radioisotopes