Evaluation of theurapeutic modalities in Graves' hyperthyroidism
Yavuz Yalcin, Oya Topaloglu, Dilek Berker, Serhat Isik & Serdar Guler
Objective: Currently there are three well-established treatment options for hyperthyroid Graves disease (GD): antithyroid drug therapy with thionamides, radioactive iodine (RAI) treatment with (131)I, and surgery. The aim of this study was to investigate retrospectively theurapeutic options of the patients with GD treated at outpatient clinics of Endocrinology and Metabolism between January 2007 and December 2009.
Methods: We evaluated 122 patients (37 male, 85 women, aged 1773 years) with GD retrospectively. Thirty-six patients (29.5%) were still on treatment so we excluded these patients. After the 18 months primary medical treatment period, recurrence rate in following one year was evaluated.
Results: Among 122 patients with GD, in 86 patients (70.5%) therapy was completed. For the therapy completed patients mean medical treatment period was 19.5±4.9 months. Among the 86 patients whose therapy was completed, in 32 patients (37.2%) relapse was not detected but in 54 patients (62.8%) disease was recurrenced. Because of the recurrence 54 patients were evaluated for surgery or RAI treatment. Thirty-nine patients (72.2%) were conducted to RAI treatment, 15 patients (27.8%) were went on surgery. Total thyroidectomy was performed. Among 39 patients who were treated with RAI, hyperthyroidism was relapsed in 5 patients (12.8%). Three of these 5 patients were conducted to second RAI treatment other 2 patients were treated by surgery. After the RAI treatment in 26 patients (66.7%) hypothyroidism has been developed. All of the 86 patients were treated with medical options initially. No adverse effects with thionamides were detected in 81 patients (94.2%). Neutropenia was seen in only 2 patients (2.3%), hepatotoxicity was developed in 3 patients (3.5%). Graves ophthalmopathy was present in only 5 patients (5.81%).
Conclusion: Medical treatment has fewer side effects and also reliable so it is the first choice in the Graves hyperthyroidism but in our study the recurrence rate was high so RAI treatment can be considered as initial option for these patients. Prospective randomized studies comparing available and novel therapeutic options of GD are needed.